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Thierry Mom, MD; Jean-Etienne Bazin, MD; Fabienne Commun, MD; Claude Dubray, MD; Alain Eschalier, MD; Catherine Derbal, MD; Paul Avan, PhD; Laurent Gilain, MD

Arch Otolaryngol Head Neck Surg. 1998;124:794-798.

Objectives  To assess the intensity of postoperative pain after laryngeal surgery for cancer and the efficacy of analgesic injections at fixed hours.

Design  A prospective clinical study performed during the 3 days following laryngeal cancer surgery.

Setting  A university medical center.

Patients  Fifteen men (age range, 38-74 years) having just undergone a partial or total laryngectomy for epidermoid carcinoma.

Interventions  The analgesic treatment consisted of intravenous administrations at fixed hours (propacetamol or nalbuphine hydrochloride), with the possibility of rescue doses on demand. Pain and anxiety were assessed by means of visual analog scales (graduated from 0-10) every 3 hours on postoperative day 1, then every 6 hours on postoperative days 2 and 3. Objective criteria, ie, heart and respiratory rates and mean blood pressure, were measured with the same schedule.

Main Outcome Measures  Postoperative pain and anxiety intensities and their variations were analyzed. Correlations between postoperative pain and other criteria were researched.

Results  Postoperative pain had a high initial level (maximum median, 7), then decreased and reached a score of 3 at the 30th hour. Unpredictable individual peaks of pain were reported. Anxiety was never high (maximum median, 4). No individual correlation was found between pain and objective parameters.

Conclusions  After laryngeal surgery for cancer, pain can reach high levels, particularly in the first hours following recovery. Analgesic administrations at fixed hours are not effective enough. Postoperative analgesic treatment should aim to prevent the high initial pain and be individually adapted.

From the Departments of Otolaryngology–Head and Neck Surgery (Drs Mom and Gilain) and Anesthesia and Intensive Care (Drs Bazin, Commun, and Derbal), University Hospital of Clermont-Ferrand; and the Departments of Clinical Pharmacology (Drs Dubray and Eschalier) and Biophysics (Dr Avan), University of Auvergne, Clermont-Ferrand, France.

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