ASSESSMENT OF POSTOPERATIVE PAIN AFTER LARYNGEAL SURGERY FOR CANCER

Objectives: To assess the intensity of postoperative pain after laryng eal surgery for cancer and the efficacy of analgesic injections at fix ed 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 un dergone a partial or total laryngectomy for epidermoid carcinoma. Inte rventions: The analgesic treatment consisted of intravenous administra tions at fixed hours (propacetamol or nalbuphine hydrochloride), with the possibility of rescue doses on demand. Pain and anxiety were asses sed by means of visual analog scales (graduated from 0-10) every 3 hou rs on postoperative day 1, then every 6 hours on postoperative days 2 and 3. Objective criteria, ie, heart and respiratory rates and mean bl ood pressure, were measured with the same schedule. Main Outcome Measu res: Postoperative pain and anxiety intensities and their variations w ere analyzed. Correlations between postoperative pain and other criter ia were researched. Results: Postoperative pain had a high initial lev el (maximum median, 7), then decreased and reached a score of 3 at the 30th hour. Unpredictable individual peaks of pain were reported. Anxi ety was never high (maximum median, 4). No individual correlation was found between pain and objective parameters. Conclusions: After laryng eal surgery for cancer, pain can reach high levels, particularly in th e first hours following recovery. Analgesic administrations at fixed h ours are not effective enough. Postoperative analgesic treatment shoul d aim to prevent the high initial pain and be individually adapted.