(A598) Perioperative Pain Control in Pediatric Head and Neck Microvascular Free Tissue Transfer: A Case Series

Introduction: Head and Neck Microvascular Free Tissue Transfer (HN-MFTT) is a major surgery performed to restore form and function following resection of pediatric head and neck tumors. While adult studies recommend multimodal analgesia (MMA) to minimize opioid use and enhance recovery, limited data exists for pediatric HN-MFTT, resulting in inconsistent pain management strategies. This study evaluates perioperative pain management strategies in pediatric HN-MFTT patients, focusing on narcotic use and length of hospital stay (LOS) in comparison to adult MMA protocols.

Methods: A retrospective case series of pediatric HN-MFTT cases was conducted at St. Jude Children’s Research Hospital from January 2020 to January 2024. Demographics, disease, treatment, and outcomes were analyzed with a focus on intraoperative and postoperative pain regimens. Our results were evaluated in context of adult MMA studies, specifically looking at differences in narcotic use patterns and LOS to identify potential areas for improvement in pediatric protocols.

Results: Eight pediatric patients underwent HN-MFTT during the study period, evenly split between benign (n=4, 50%) and malignant (n=4, 50%) tumors. All underwent fibula free flap reconstruction (n=8, 100%) with tracheostomy (n=8, 100%). Postoperative patient-controlled analgesia (PCA) pumps were used universally (87.5% hydromorphone, 12.5% fentanyl). Other medications included intravenous acetaminophen (n=7, 87.5%), gabapentin (n=2, 25%), and oxycodone (n=1, 12.5%). Median LOS was 12.5 days (range: 8-19 days). One patient required a takeback for donor site morbidity.

Conclusions: Pain control strategies for pediatric HN-MFTT were highly variable, with heavy reliance on narcotics and prolonged LOS compared to adult MMA protocols. Pediatric-specific MMA regimens may optimize pain management, reduce opioid use, and improve recovery outcomes in this unique population.