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Nearly all patients report adequate pain control after Mohs surgery

After Mohs micrographic surgery, patients report adequate pain control in 97% of all 8-hour increments based on pain diary results, indicating appropriate pain management overall after surgery, according to findings published in Journal of the American Academy of Dermatology.

The researchers determined optimal timing and type of pharmacological pain control after Mohs micrographic surgery by using a patient pain diary starting in postoperative day 0 (POD0) at 2 p.m. and continued in 8-hour increments until POD4 at 6 a.m. Patients recorded their worst pain rating on a scale of 0 to 10, the type of pain medication used and whether they felt the pain was well controlled.

Patients were prescribed six tramadol 50 mg tablets for dosing every 4 to 6 hours as needed for postoperative pain rated as at least 7. For lesser pain, patients were advised to take acetaminophen and/or NSAIDs.

Of 400 total patients, 253 returned the survey (mean age, 71 years; 65% men).

Forty-five percent of cases occurred on the eyelids, noses or lips; on the head and neck in 46%; on the trunk or extremity sites in 8% and less than 1% on genital sites, the researchers wrote.

The average postoperative defect size was 2.87 cm², with linear repairs accounting for 61% of cases, flaps for 21%, second intention healing for 13% and full-thickness skin grafts in 4%, according to the data.

Pain was “well controlled” in 97% of the 8-hour increments. Twenty-two percent of patients used narcotics at least once during the study, the researchers reported.

The greatest average pain was reported on POD0 from 2 p.m. to 10 p.m., which researchers determined as when the perioperative anesthetic likely lost effect.

Pain scores gradually decreased from the peak average score of 3 on POD0 from 2 p.m. to 10 p.m. and eventually approached zero at the end of the study period, according to researchers.

The inability to determine whether tramadol is as effective as other narcotics for Mohs micrographic surgery-related postoperative pain control was listed as a study limitation.

If indicated, the researchers recommend prescribing a small quantity of narcotics for pain control before patients leave the office because pain typically spikes at POD0 from 2 p.m. to 10 p.m. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.