Inpatient Opioid Use in Head and Neck Microvascular Free Flap Reconstruction

Abstract Objectives The primary objective is to determine whether patients undergoing osseous microvascular free flap reconstruction of head and neck defects have higher inpatient pain requirements than those undergoing nonosseous reconstruction. Secondary aims include evaluating the impact of a multimodal analgesia (MMA) protocol and COVID‐19 visitor restrictions on inpatient opioid administration. Study Design Retrospective chart review. Setting MedStar Georgetown University Hospital and MedStar Washington Hospital Center. Methods Narcotic doses administered during the perioperative inpatient hospitalization were converted to morphine‐equivalent doses (MEDs) for comparison. 2‐tailed t tests and χ 2 analyses were used, with P ≤ .05 as the threshold for statistical significance. Results 318 patients (mean age 64 ± 12.3 years; 65% male) were included. Total inpatient MED was 224.48 and 173.88 in the osseous and nonosseous free flap cohorts, respectively ( P = .127295). The total MED per day of hospitalization was 16.38 and 17.53, respectively ( P = .671399). Implementation of an MMA protocol reduced daily MED from an average of 25.9 to 11.24 ( P < .0001). During COVID‐19 visitor restrictions, total and daily MEDs were 234.57 and 20.64, respectively, compared to 181.32 and 16.9 during unrestricted periods, though these differences were not statistically significant ( P = .163232 and P = .251387, respectively). Conclusions The findings suggest no significant difference in postoperative MME between patients undergoing osseous versus non‐osseous free flap reconstruction, and inpatient opioid pain requirements did not differ between groups. MMA protocol implementation was associated with a significant reduction in inpatient narcotic use, while COVID‐19 visitor restrictions had no significant effect. Level of Evidence 4.