Effects of popliteal nerve blocks on postoperative pain management in fibula‐free flap patients for head and neck cancer reconstruction

Objective To determine if performing popliteal nerve blocks preoperatively in patients undergoing fibula‐free flap surgery for head and neck cancer reconstruction decreases subjective pain scores decreases narcotic usage, and improves mobility in the acute postoperative time period when compared to alternative pain control regimens. Methods A retrospective review of the medical records of patients who underwent fibula‐free flap reconstruction for head and neck malignancy at SUNY Upstate Medical University during the time period from 2015 to 2022 was performed. Collected data consisted of patient demographics and clinical characteristics, postoperative pain management modalities, reported pain scores, postoperative narcotic usage, length of hospital stay, and days until out of bed without personal assistance. Results A total of 40 patients were included in the study. The average reported pain score was reduced in the nerve block group compared to the control group (1.7 vs. 4.0, p‐value = .003). Similarly, the average maximum reported pain score was also lower in patients who received a nerve block (3.4 vs. 6.9, p‐value = .002). None of the patients who received popliteal nerve blocks required pain control with parenteral narcotics postoperatively, whereas 82.9% of patients without a nerve block did. Patients who received a popliteal nerve block consumed an average of 103.5 MME, whereas those who did not receive a block consumed an average of 523.0 MME. No statistically significant difference was found between the groups regarding time from surgery until transfer without personal assistance or length of hospital stay. Conclusion Popliteal nerve blocks can reduce postoperative pain in patients undergoing fibula‐free flap reconstruction for head and neck cancer. This study analyzes the effects of popliteal nerve blocks on postoperative pain and outcomes in patients with advanced head and neck cancer undergoing fibula‐free flap reconstruction. We found that patients who received popliteal nerve blocks had decreased pain‐reported scores, did not require IV narcotics, and had a trend toward decreased MME usage during the postoperative time period in comparison to patients using traditional pain control methods.