Persistent Postsurgical Pain in Oral Cancer Patients Reconstructed with Anterolateral Thigh Free Flap
Abstract
:1. Introduction
2. Materials and Methods
2.1. General Anesthesia and Operative Procedures
2.2. Measurement of Donor and Receipt Sites Postsurgical Pain Characters
2.3. Assessment of Health-Related Cancer Quality of Life
2.4. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Cancer-Related Quality of Life Assessment
3.3. Sensory Test
3.4. Patient-Reported Spontaneous Pain Characteristics
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Postoperative Stages | Early (6 m–1 y) (n = 26) | Mid (1–2 y) (n = 37) | Late (>2 y) (n = 31) | p Value |
---|---|---|---|---|
Gender | ||||
Male | 24 (92.3%) | 37 (100%) | 29 (93.5%) | 0.251 |
Female | 2 (7.7%) | 0 (0%) | 29 (6.5%) | |
Age, y/o # | 54.7 [51.1–58.3] | 56.3 [53.4–59.3] | 55.4 [52.4–58.4] | 0.764 |
Education | ||||
Elementary | 13 (50.0%) | 13 (35.1%) | 13 (42.0%) | 0.701 |
Junior | 7 (26.9%) | 12 (32.4%) | 7 (22.6%) | |
Senior or above | 6 (23.1%) | 12 (32.4%) | 11 (35.5%) | |
Marital status | ||||
Married living together | 16 (61.5%) | 29 (78.4%) | 25 (80.6%) | 0.323 |
Divorced/Widowed/ Never married | 10 (38.5%) | 8 (21.6%) | 6 (19.4%) | |
Work | ||||
Out of work/Retired | 18 (69.2%) | 23 (62.2%) | 18 (58.1%) | 0.779 |
Employed | 8 (30.8%) | 14 (37.8%) | 13 (41.9%) | |
Systemic diseases | ||||
None | 16 (61.5%) | 23 (62.2%) | 23 (74.2%) | 0.888 |
Diabetes | 2 (7.7%) | 3 (8.1%) | 2 (6.5%) | |
Hypertension | 6 (23.1%) | 7 (18.9%) | 3 (9.7%) | |
Diabetes and hypertension | 2 (7.7%) | 4 (10.8%) | 3 (9.7%) | |
Cancer Stage | ||||
Stage Ⅰ | 2 (7.7%) | 5 (13.5%) | 2 (6.7%) | 0.689 |
Stage Ⅱ | 1 (3.8%) | 2 (5.4%) | 4 (13.3%) | |
Stage Ⅲ | 5 (19.2%) | 4 (10.8%) | 5 (16.7%) | |
Stage Ⅳ | 18 (69.2%) | 26 (70.3%) | 19 (63.3%) | |
Donor Site | ||||
Single ALT | 25 (96.2%) | 35 (100%) | 29 (93.6%) | 0.331 |
Double ALT | 1 (3.8%) | 0 (0%) | 2 (6.4%) |
Content Area (Scale) | Items | Early (6 m–1 y) (n = 26) | Mid (1–2 y) (n = 37) | Late (>2 y) (n = 31) | p Value |
---|---|---|---|---|---|
Mean (SD) | Mean (SD) | Mean (SD) | |||
Global health status (1) | (29,30) | 53.5 (21.4) | 63.5 (19.8) | 70.4 (18.0) | 0.007 * |
Functional (1) | |||||
Role functioning | (6,7) | 76.3 (29.9) | 86.9 (16.3) | 90.3 (13.5) | 0.030 * |
Physical functioning | (1~5) | 80.8 (18.2) | 82.2 (14.8) | 86.9 (12.7) | 0.272 |
Social functioning | (26,27) | 69.9 (25.4) | 79.3 (20.6) | 87.1 (23.1) | 0.021 * |
Emotional functioning | (21~24) | 80.8 (16.5) | 84.0 (16.8) | 86.6 (14.7) | 0.402 |
Cognitive functioning | (20,25) | 78.2 (23.5) | 79.7 (15.3) | 84.4 (16.6) | 0.399 |
Symptom/problem items (2) | |||||
Pain | (9,19) | 22.4 (28.3) | 18.5 (18.8) | 10.2 (15.9) | 0.082 |
Insomnia | (11) | 41.0 (34.4) | 27.0 (31.3) | 19.4 (28.3) | 0.036 * |
Financial difficulties | (28) | 32.1 (37.1) | 33.3 (35.1) | 28.0 (32.3) | 0.809 |
Fatigue | (10,12,18) | 25.2 (23.0) | 15.6 (17.3) | 6.5 (11.7) | <0.001 * |
Nausea and Vomiting | (14,15) | 0 (0.0) | 3.2 (10.3) | 0 (0.00) | 0.075 |
Constipation | (16) | 14.0 (25.3) | 11.7 (23.9) | 5.4 (19.4) | 0.323 |
Dyspnea | (8) | 10.3 (18.3) | 11.7 (19.6) | 7.5 (14.2) | 0.619 |
Diarrhea | (17) | 3.8 (10.9) | 1.8 (7.6) | 4.3 (11.4) | 0.542 |
Appetite loss | (13) | 7.7 (21.7) | 6.3 (17.3) | 3.2 (13.2) | 0.607 |
Variables | Early (6 m–1 y) (n = 26) | p Value | Mid (1–2 y) (n = 37) | p Value | Late (>2 y) (n = 31) | p Value | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Contralateral | Donor | Contralateral | Donor | Contralateral | Donor | ||||||||||
Normal | Abnormal | Normal | Abnormal | Normal | Abnormal | Normal | Abnormal | Normal | Abnormal | Normal | Abnormal | ||||
Medial thigh portion | |||||||||||||||
Touch | 26 | 0 | 15 | 11 | <0.001 * | 37 | 0 | 17 | 20 | <0.001 * | 31 | 0 | 15 | 16 | <0.001 * |
0.641 # | |||||||||||||||
Pressure | 26 | 0 | 13 | 13 | <0.001 * | 37 | 0 | 13 | 24 | <0.001 * | 31 | 0 | 10 | 21 | <0.001 * |
0.343 # | |||||||||||||||
Pin-prick | 26 | 0 | 14 | 11 | <0.001 * | 37 | 0 | 14 | 23 | <0.001 * | 31 | 0 | 7 | 24 | <0.001 * |
0.052 # | |||||||||||||||
Cold | 26 | 0 | 14 | 12 | <0.001 * | 37 | 0 | 17 | 20 | <0.001 * | 31 | 0 | 12 | 19 | <0.001 * |
0.520 # | |||||||||||||||
Warm | 26 | 0 | 14 | 12 | <0.001 * | 37 | 0 | 19 | 18 | <0.001 * | 31 | 0 | 12 | 19 | <0.001 * |
0.451 # | |||||||||||||||
Lateral thigh portion | |||||||||||||||
Touch | 26 | 0 | 12 | 14 | <0.001 * | 37 | 0 | 16 | 21 | <0.001 * | 31 | 0 | 17 | 14 | <0.001 * |
0.621 # | |||||||||||||||
Pressure | 26 | 0 | 7 | 19 | <0.001 * | 37 | 0 | 10 | 27 | <0.001 * | 31 | 0 | 10 | 21 | <0.001 * |
0.868 # | |||||||||||||||
Pin-prick | 26 | 0 | 5 | 21 | <0.001 * | 37 | 0 | 6 | 31 | <0.001 * | 31 | 0 | 9 | 22 | <0.001 * |
0.007 & | 0.036 & | 0.418 # | |||||||||||||
Cold | 26 | 0 | 6 | 20 | <0.001 * | 37 | 0 | 8 | 29 | < 0.001 * | 31 | 0 | 10 | 21 | <0.001 * |
0.023 & | 0.027 & | 0.572 # | |||||||||||||
Warm | 26 | 0 | 6 | 20 | <0.001 * | 37 | 0 | 11 | 26 | <0.001 * | 31 | 0 | 8 | 23 | <0.001 * |
0.023 & | 0.058 & | 0.310 # |
Variables | (N) | Early (6 m–1 y) | (N) | Mid (1–2 y) | (N) | Late (>2 y) | |||
---|---|---|---|---|---|---|---|---|---|
Positive | Negative | Positive | Negative | Positive | Negative | ||||
Medial thigh portion | |||||||||
Touch | (n = 11) | 1 | 10 | (n = 20) | 6 | 14 | (n = 16) | 1 | 15 |
Pressure | (n = 13) | 2 | 11 | (n = 24) | 6 | 18 | (n = 21) | 1 | 20 |
Pin-prick | (n = 12) | 4 | 8 | (n = 23) | 10 | 13 | (n = 24) | 9 | 15 |
Cold | (n = 12) | 3 | 9 | (n = 20) | 3 | 17 | (n = 19) | 4 | 15 |
Warm | (n = 12) | 0 | 12 | (n = 18) | 1 | 17 | (n = 19) | 5 | 14 |
Lateral thigh portion | |||||||||
Touch | (n = 14) | 1 | 13 | (n = 21) | 1 | 20 | (n = 14) | 1 | 13 |
Pressure | (n = 19) | 2 | 17 | (n = 27) | 0 | 27 | (n = 20) | 1 | 20 |
Pin-prick | (n = 21) | 5 | 16 | (n = 31) | 5 | 26 | (n = 22) | 8 | 14 |
Cold | (n = 20) | 2 | 18 | (n = 29) | 2 | 27 | (n = 21) | 1 | 20 |
Warm | (n = 20) | 1 | 19 | (n = 26) | 0 | 26 | (n = 23) | 1 | 22 |
Variables | Early (6 m–1 y) (n = 26) | Mid (1–2 y) (n = 37) | Late (>2 y) (n = 31) | p Value |
---|---|---|---|---|
Spontaneous Pain | ||||
No | 11 (42.3%) | 11 (29.7%) * | 18 (58%) * | 0.061 |
Yes | 15 (57.7%) | 26 (72.3%) * | 13 (42%) * | |
Pain Location | ||||
Donor site | 12 (80%) | 21 (80.8%) | 12 (92.3%) | 0.334 |
Receipt site | 1 (6.6%) | 0 (0%) | 0 (0%) | |
Not surgical site | 2 (13.4%) | 5 (19.2%) | 1 (7.7%) | |
Pain Pattern | ||||
Constant | 0 (0%) | 2 (7.7%) | 0 (0%) | 0.490 |
Intermittent | 15 (100%) | 24 (92.3%) | 13 (100%) | |
Characters | ||||
Pricking | 0 (0%) | 1 (3.8%) | 1 (7.7%) | 0.440 |
Twitch | 3 (20%) | 5 (19.2%) | 2 (15.4%) | |
Dullness | 0 (0%) | 1 (3.8%) | 1 (7.7%) | |
Dysesthesia | 6 (40%) | 13 (50%) | 7 (53.8%) | |
Numb | 6 (40%) | 6 (23.2%) | 2 (15.4%) |
Variables | Early (6 m–1 y) | Mid (1–2 y) | Late (>2 y) | p Value |
---|---|---|---|---|
(n = 26) | (n = 37) | (n = 31) | ||
Pain need to be treated | ||||
No | 21 (80.8%) | 27 (73.0%) | 30 (96.8%) | 0.032 * |
Yes | 5 (19.2%) | 10 (27.0%) | 1 (3.2%) | |
NRS (total) | 1.6 ± 1.7 | 2.1 ± 2.0 | 0.7 ± 1.0 | 0.006 * |
NRS (be treated) | 2.7 ± 1.4 | 2.9 ± 1.7 | 1.8 ± 0.8 | 0.071 |
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Shen, Y.-C.; Liao, K.-L.; Cheng, K.-I.; Tseng, K.-Y.; Su, M.-P. Persistent Postsurgical Pain in Oral Cancer Patients Reconstructed with Anterolateral Thigh Free Flap. Medicina 2022, 58, 391. https://doi.org/10.3390/medicina58030391
Shen Y-C, Liao K-L, Cheng K-I, Tseng K-Y, Su M-P. Persistent Postsurgical Pain in Oral Cancer Patients Reconstructed with Anterolateral Thigh Free Flap. Medicina. 2022; 58(3):391. https://doi.org/10.3390/medicina58030391
Chicago/Turabian StyleShen, Ya-Chun, Kuei-Lin Liao, Kuang-I Cheng, Kuang-Yi Tseng, and Miao-Pei Su. 2022. "Persistent Postsurgical Pain in Oral Cancer Patients Reconstructed with Anterolateral Thigh Free Flap" Medicina 58, no. 3: 391. https://doi.org/10.3390/medicina58030391