Pain severity and quality of life following major mandibular reconstructive surgery in head neck cancer

Background: Pain is a common symptom in patients undergoing major mandibular surgeries and reconstruction. To date, no studies have been done to assess the severity of pain and its effect on the quality of life post this surgery. Aim: To assess pain severity in the perioperative period and its impact on quality of life in head-and-neck cancer patients undergoing major mandibular resection with reconstruction. Primary Objective: To assess pain severity in the first 7 days following surgery. Secondary Objective: To identify the proportion of patients who continue to have pain at 4-month postsurgery and its impact on quality of life. Design: Prospective observational study. Materials and Methods: This study was conducted in a tertiary care cancer center. Between February and June 2016, 51 head-and-neck cancer patients undergoing reconstructive surgery were enrolled in the study after written informed consent. The pain was assessed using an 11-point Numerical rating scale (NRS) preoperatively, at 7 days, 1- and 4-month postsurgery, and quality of life was assessed by brief pain inventory (BPI). Results: Moderate-to-severe pain was reported by 46 patients (90.2%) on the 1st day and 44 patients (86.3%) on the 2nd post-operative day, which reduced to 27 patients (52.9%) over the next 2 days. By day 5, 48 (94.1%) patients had mild pain. By 1 month, 39 patients (76.5%) had moderate pain. By 4 months, 49 patients (96.1%) had mild pain, while two patients (3.9%) had severe pain. Quality of life was maximally affected at the end of the 1st month in all patients. At 4 months, only 1 (2%) patient had the affection of quality of life. This patient had severe preoperative pain. Conclusion: In patients undergoing extensive resection and reconstruction, moderate-to-severe pain was noted not only in the immediate postoperative period, but up to 1-month postsurgery and affected their quality of life. Stringent perioperative analgesia guidelines are needed in managing such patients and improving their quality of life.