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Background and Aims Pain management after head and neck cancer free flap reconstruction is complicated by the different sites of surgery; the primary cancer site and the donor flap site. Perioperative analgesia has moved towards multi-modal analgesia (MMA) and this technique has been endorsed by the Society for Head and Neck Anesthesia (1). Although the primary cancer site is not conducive to conventional regional anaesthesia (RA) techniques, the donor flap site is often harvested from peripheral limbs and RA can play a key component of MMA. The aim of this report is to describe our current intraoperative analgesic regimes for patients undergoing free flap (FF) reconstruction for head and neck cancer surgery.

Methods This is a retrospective review of adult patients undergoing elective head and neck FF reconstructive surgery over an 8 month period (September 2023-April 2024) at a tertiary hospital (50-60 cases/year). Patients who underwent rescue FF or regional flaps were excluded.

Results 28 patients received FF reconstruction surgery with 29 flaps (table 1). All patients received MMA adjuncts in combination with opioids, with a significant proportion of patients receiving RA after flap harvesting (table 2). The commonest RA technique performed targeted the femoral nerve, reflecting the most frequent flap harvested (ALT), with popliteal blocks used for fibula flaps (chart 1).

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Abstract EP185 Chart 1

Regional anaesthesia blocks performed

Conclusions At our centre we demonstrated a high level of MMA, including RA, for patients undergoing head and neck cancer FF reconstruction. We advocate that ‘Plan A’ blocks can be used as part of MMA to reduce perioperative opioids and their associated side-effects.