title: Cranio-maxillofacial reconstruction with microvascular radialis flaps-parameters and correlations of postoperative pain management.
abstract: OBJECTIVE
  Postoperative pain management is of highest interest for patients undergoing maxillofacial surgery including microvascular reconstructive surgery. Currently, there is a lack of information regarding process and outcome of postoperative pain management after microvascular reconstruction.
  
  
  METHODS
  In a prospective clinical study, 31 adults were evaluated on the first postoperative day following microvascular reconstruction with a radial forearm flap using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It enables a standardized assessment of patients' characteristics, pain parameters, outcome and pain therapy process parameters.
  
  
  RESULTS
  Pain management consisted predominately of premedication with midazolam, sufentanil and metamizol intraoperatively, piritramid in the intensive care unit and metamizol, tramadol and fentanyl patches on ward. Nineteen patients (61.3 %) showed inadequate pain management with pain levels ≥4. Among other significant relations, patients exhibiting an age below the median presented significant higher levels of pain under strain (p = .041) and maximum pain (p = .006) as well as rate of breathing (p = .009) and mood (p = .006) disturbance. Performance of pain counselling showed specific impact on pain under strain (p = .008), maximum pain (p = .004) and satisfaction with pain intensity (p = .001). Whether microvascular reconstruction was performed with primary or secondary intention or performance of a neck dissection did not show significant influence.
  
  
  CONCLUSIONS
  QUIPS helped us to adequately evaluate the procedure-specific quality of postoperative management following microvascular reconstruction with a radial forearm flap. It helped us to identify a surprisingly high amount of inadequate pain management. Postoperative pain levels seem to be primarily influenced by the performed reconstruction.
  
  
  CONCLUSIONS
  Establishment of a continuous and procedure-specific evaluation of postoperative pain levels should help to avoid inadequate pain management, which is widely prevalent according to the literature and our study. Preoperative pain counselling is essential and should be procedure specific to be its best.
authors.affiliation: Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. raschke.gregor@googlemail.com.
authors.forename: Gregor F
authors.initials: GF
authors.lastname: Raschke
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Meissner
authors.affiliation: Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Andre
authors.initials: A
authors.lastname: Peisker
authors.affiliation: Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Djedovic
authors.affiliation: Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rieger
authors.affiliation: Marquette University School of Dentistry, Milwaukee, WI, USA.
authors.forename: Arndt
authors.initials: A
authors.lastname: Guentsch
authors.affiliation: Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Daria
authors.initials: D
authors.lastname: Porwit
authors.affiliation: Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Marta Gomez
authors.initials: MG
authors.lastname: Dammeier
authors.affiliation: Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schultze-Mosgau
mesh_terms: D000328:Adult; D005260:Female; D005858:Germany; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D017534:Radial Artery; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Microvascular reconstruction; Postoperative pain; QUIPS; Radialis flap