A Randomized Controlled Trial Comparing Preemptive Versus On Demand Administration of Analgesics after Mohs Surgery and Cutaneous Reconstruction

BACKGROUND: Mohs Micrographic Surgery (MMS) affords a high cure rate for cutaneous carcinoma. OBJECTIVE: This study was designed to characterize the pain patients experience after MMS and reconstruction of the head and neck, and to determine if preemptive dosing of analgesics was superior to patient‐initiated dosing on an "as needed" basis. METHODS: A controlled trial of 200 subjects undergoing MMS and reconstruction of skin cancers on the head and neck were randomized to either receive acetaminophen at the time of discharge or to take it on an "as needed" basis. The two groups were evaluated for differences in peak pain, satisfaction with pain management, and the need for narcotic analgesic "rescue" postoperatively. RESULTS: Peak pain levels after surgery were surprisingly low and rated, on average, 2/10 using an analog pain scale. Peak pain occurred at four hours postoperatively for both subgroups and patients were satisfied with pain control 72.5% of the time. There was no significant difference in any of the parameters between the two dosing regimens. CONCLUSIONS: Mohs surgery peak pain typically occurs four hours postoperatively. Patient satisfaction with pain management was high with acetaminophen regardless of the dosing regimen. Preemptive analgesia with acetaminophen does not appear to be superior to "as‐