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Head and Neck Surgery

(280) Intraoperative Cold Saline Irrigation for Pain in Transoral Robotic Surgery

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Joshua D. Barlow, BA

    Medical Student
    Icahn School of Medicine at Mount Sinai
    New York, NY, USA

    • Author(s)

  • Andrey Filimonov, MD

    Fellow
    Department of Otolaryngology, University of Pittsburgh Medical Center
    Newark, New Jersey, USA

  • Brandon S. Gold, BS

    Medical Student
    Icahn School of Medicine at Mount Sinai
    New York, New York, USA

  • SR

    Scott A. Roof, MD

    Assistant Professor
    Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai
    New York, NY, USA

  • Marita S. Teng, MD

    Professor
    Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai
    New York, NY, USA

  • MG

    Mingyang L. Gray, MD, MPH

    Assistant Professor
    Icahn School of Medicine at Mount Sinai
    New York , NY, USA

    • Senior Author(s)

  • EG

    Eric M. Genden, Sr., MD

    Professor and Chairman
    Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai
    New York, NY, USA

Introduction: Cold saline irrigation is hypothesized to mitigate inflammatory processes in surgical cases, and has been studied with conflicting results since the 1980s. Our study explores this method for pain management in postoperative transoral robotic surgery (TORS) patients.

Methods: This single-blind, randomized controlled trial was comprised of patients undergoing TORS for squamous cell carcinoma of the base of tongue (BOT) or tonsil from September 2019-March 2022 at an urban, tertiary medical center. Consenting patients were randomized into a treatment group receiving intraoperative cold (4-6ºC) saline irrigation of the operative site, or a control group receiving room temperature irrigation. The primary outcome measure was visual analog scale (VAS) pain scores taken every eight hours for 72 hours postoperatively. Secondary outcomes included 72-hour postoperative morphine equivalent dose taken for pain management, length of hospital stay, and University of Washington Quality of Life (UW-QOL) score taken two weeks postoperatively.

Results: The study population comprised 31 patients, with 9 belonging to the BOT treatment group, 9 the BOT control group, 6 the tonsil treatment group, and 7 the tonsil control group. The BOT treatment group had lower median VAS scores than the control group both at rest (14.7 vs. 31.9, p = .112) and while swallowing (34.3 vs. 69.0, p = 0.179), but these results did not achieve statistical significance. The BOT treatment group had statistically significantly higher median UW-QOL scores than the control group (75.0 vs. 59.5, p = .022). No significant differences were found between BOT groups in postoperative morphine equivalent dose or length of hospital stay. No significant differences were found between tonsil groups on any of the four outcome measures.

Conclusions: These findings suggest that cold saline irrigation does not provide significant benefit for TORS tonsil patients, however there may be potential benefits, particularly in quality of life, for BOT patients. Further studies are necessary to assess optimal interventions for pain control and quality of life outcomes.