Resident Physician University of Pittsburgh Medical Center University of Pittsburgh Medical Center Pittsburgh, Pennsylvania
Educational Objective: At the conclusion of this presentation, the participants should be able to understand the existing literature regarding pain following transoral robotic surgery. Participants should also learn that there are significant gaps regarding the time course of postoperative pain, the impact on the healthcare system, and optimal treatment.
Objectives: Pain following transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) is a driver of adverse outcomes, and no consensus exists regarding optimal treatment. This study's objective was to characterize existing literature regarding pain following TORS.
Study Design: Scoping review.
Methods: Search criteria were developed and used to query OVID Medline, CINAHL, Cochrane, PubMed, and Embase databases. Two team members independently screened titles and abstracts and completed full text reviews. Studies examining TORS for OPSCC with quantitative pain data were included. Conflicts were resolved among two team members. Data was extracted using guidelines from Cochrane. The study followed the PRISMA guidelines and was registered with the Open Science Framework.
Results: 1467 studies were imported for screening and 624 duplicates were removed. 807 studies were excluded during title and abstract screening. Of the remaining 36 studies, 25 studies were ultimately included. The average study sample size was 89 participants. 68% were conducted in a single center academic setting. Pain was assessed using 13 different metrics (e.g., visual analog scale, UW-QOL). The study intervals ranged from postoperative days 1-15 and up to 2 years following TORS. Studies found that TORS pain is similar to tonsillectomy related pain, peaks several weeks postoperatively, decreases between 1 and 6 months and returns to baseline thereafter. Postoperative pain is a significant cause of hospital readmissions. No clinical trials have demonstrated a significant benefit for NSAIDs or steroids.
Conclusions: Studies specifically evaluating pain following TORS are small and heterogeneous. Further prospective studies are needed to characterize TORS associated pain and to develop optimal treatment strategies.