Abstract:IMPORTANCE Up to 80% of patients with head and neck cancer undergoing ablative surgery and neck dissection develop postoperative pain with detrimental effects on quality of life that also contributes to neuropathic and chronic postoperative pain.OBJECTIVE To investigate the association of continuous local anesthetic wound infusion with pain management after head and neck surgery.DESIGN, SETTING, AND PARTICIPANTS This prospective, longitudinal, nonrandomized clinical study carried out in a single tertiary refer… Show more
“…In all, we applaud the work by Gostian and colleagues, and we join them in seeking better characterization and treatment options following head and neck cancer surgery.…”
mentioning
confidence: 77%
“…To the Editor With great anticipation we read the recent article titled “Postoperative Pain Treatment with Continuous Local Anesthetic Wound Infusion in Patients with Head and Neck Cancer: A Nonrandomized Clinical Trial.” Of primary importance, the authors should be singularly commended for pursuing treatment alternatives away from standard opioid administration. As we join a number of institutions following the example of Gostian and colleagues, we felt it prudent to specify details that may limit clinical application of the specific technique described to optimize future efforts.…”
mentioning
confidence: 99%
“…This tool may not be appropriate because we are not aware that the questionnaire is validated or used for postsurgical pain, specifically with the manifestations of acute pain being altered so close to surgery. Despite the authors’ assurances to the contrary, placing the surgical drain and the catheter in different locations within a continuous fascial space would leave concern for suctioning the anesthetic. In the discussion, the authors discuss the potential training benefit of acute pain blocks, but the prospective trial did not track outcomes beyond 4 days (even with discontinued catheters) to investigate the entire course of recovery.…”
712 268. Based on low estimates for each event, the number of US individuals who are expected to develop COD is 170 238, and based on the highest estimate, the number is 1 600 241.Discussion | This analysis of new daily cases of COVID-19, acute incidence of OD, and rates of recovery suggest that more than 700 000, and possibly as many as 1.6 million, US individuals experience COD because of SARS-CoV-2. To put this number in context, before the COVID-19 pandemic, the National Institute on Deafness and Other Communication Disorders estimated that, among US adults 40 years or older, measurable OD was found in up to 13.3 million adults. 6 Notably, the agespecific prevalence of OD is 4.2% for individuals between age 40 to 49 years and 39.4% for individuals 80 years and older. The addition of 0.7 to 1.6 million new cases of COD represents a 5.3% to 12% relative increase. COVID-19 affects a younger demographic group than other causes of OD. Thus, the lifelong burden of OD will be much greater for the COVID-19 cohort than for patients in the older age groups. The true number of COD may be far higher than the results in this article indicate. The main limitation of this study is the inability to obtain the true number of cases, as state-reported positive cases likely underestimate the true number of positive cases. Furthermore, the estimates for the incidence of acute and chronic OD are derived from relatively healthier, ambulatory patients. The incidence of OD may be higher among patients who were hospitalized with SARS-CoV-2. These data suggest an emerging public health concern of OD and the urgent need for research that focuses on treating COVID-19 COD.
“…In all, we applaud the work by Gostian and colleagues, and we join them in seeking better characterization and treatment options following head and neck cancer surgery.…”
mentioning
confidence: 77%
“…To the Editor With great anticipation we read the recent article titled “Postoperative Pain Treatment with Continuous Local Anesthetic Wound Infusion in Patients with Head and Neck Cancer: A Nonrandomized Clinical Trial.” Of primary importance, the authors should be singularly commended for pursuing treatment alternatives away from standard opioid administration. As we join a number of institutions following the example of Gostian and colleagues, we felt it prudent to specify details that may limit clinical application of the specific technique described to optimize future efforts.…”
mentioning
confidence: 99%
“…This tool may not be appropriate because we are not aware that the questionnaire is validated or used for postsurgical pain, specifically with the manifestations of acute pain being altered so close to surgery. Despite the authors’ assurances to the contrary, placing the surgical drain and the catheter in different locations within a continuous fascial space would leave concern for suctioning the anesthetic. In the discussion, the authors discuss the potential training benefit of acute pain blocks, but the prospective trial did not track outcomes beyond 4 days (even with discontinued catheters) to investigate the entire course of recovery.…”
712 268. Based on low estimates for each event, the number of US individuals who are expected to develop COD is 170 238, and based on the highest estimate, the number is 1 600 241.Discussion | This analysis of new daily cases of COVID-19, acute incidence of OD, and rates of recovery suggest that more than 700 000, and possibly as many as 1.6 million, US individuals experience COD because of SARS-CoV-2. To put this number in context, before the COVID-19 pandemic, the National Institute on Deafness and Other Communication Disorders estimated that, among US adults 40 years or older, measurable OD was found in up to 13.3 million adults. 6 Notably, the agespecific prevalence of OD is 4.2% for individuals between age 40 to 49 years and 39.4% for individuals 80 years and older. The addition of 0.7 to 1.6 million new cases of COD represents a 5.3% to 12% relative increase. COVID-19 affects a younger demographic group than other causes of OD. Thus, the lifelong burden of OD will be much greater for the COVID-19 cohort than for patients in the older age groups. The true number of COD may be far higher than the results in this article indicate. The main limitation of this study is the inability to obtain the true number of cases, as state-reported positive cases likely underestimate the true number of positive cases. Furthermore, the estimates for the incidence of acute and chronic OD are derived from relatively healthier, ambulatory patients. The incidence of OD may be higher among patients who were hospitalized with SARS-CoV-2. These data suggest an emerging public health concern of OD and the urgent need for research that focuses on treating COVID-19 COD.
“…In Reply We thank Drs Rahman and Mendelsohn for their interest in our recent study . The performance of a neck dissection has been shown to be associated with great and potentially long-lasting pain and is therefore also listed in the German S3 guideline for acute postoperative pain as a surgical procedure with expected high pain levels.…”
mentioning
confidence: 77%
“…The catheter was inserted in the surgical field as far away from the drain as possible to minimize aspiration through the drain . In our opinion, complete aspiration of the agent by the drainage is also not consistent with the emphasized positive effects of local pain therapy in the first 2 days.…”
712 268. Based on low estimates for each event, the number of US individuals who are expected to develop COD is 170 238, and based on the highest estimate, the number is 1 600 241.Discussion | This analysis of new daily cases of COVID-19, acute incidence of OD, and rates of recovery suggest that more than 700 000, and possibly as many as 1.6 million, US individuals experience COD because of SARS-CoV-2. To put this number in context, before the COVID-19 pandemic, the National Institute on Deafness and Other Communication Disorders estimated that, among US adults 40 years or older, measurable OD was found in up to 13.3 million adults. 6 Notably, the agespecific prevalence of OD is 4.2% for individuals between age 40 to 49 years and 39.4% for individuals 80 years and older. The addition of 0.7 to 1.6 million new cases of COD represents a 5.3% to 12% relative increase. COVID-19 affects a younger demographic group than other causes of OD. Thus, the lifelong burden of OD will be much greater for the COVID-19 cohort than for patients in the older age groups. The true number of COD may be far higher than the results in this article indicate. The main limitation of this study is the inability to obtain the true number of cases, as state-reported positive cases likely underestimate the true number of positive cases. Furthermore, the estimates for the incidence of acute and chronic OD are derived from relatively healthier, ambulatory patients. The incidence of OD may be higher among patients who were hospitalized with SARS-CoV-2. These data suggest an emerging public health concern of OD and the urgent need for research that focuses on treating COVID-19 COD.
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