Head and neck photoimmunotherapy is a novel treatment for the local control of head and neck carcinoma that utilizes cetuximab sarotalocan-sodium (Akalux®) and a laser system to target tumor cells selectively. Photoimmunotherapy has been associated with severe pain during laser irradiation and during the postoperative period, along with tongue swelling and laryngeal edema following surgery. We attempted to manage postoperative pain and airway complications in a patient who underwent photoimmunotherapy for recurrent maxillary gingival cancer. Akalux® was administered intravenously on the day before the surgery. Anesthesia was maintained with sevoflurane, intravenous remifentanil, and fentanyl. Following a tracheostomy, intravenous patient-controlled analgesia (IV-PCA) with fentanyl (20 μg/h, bolus dose of 10 μg, lockout time of 20 minutes) was initiated. Infiltration anesthesia with 1.5 mL of 2% lidocaine was applied, followed by a needle puncture for irradiation. During the surgery, the patient received 1,000 mg of acetaminophen and 50 mg of flurbiprofen axetil intravenously, followed by infiltration anesthesia with 4 mL of 0.75% ropivacaine. The NRS score upon ICU admission was 5, but the score decreased to 1 after six hours of IV-PCA. IV-PCA was discontinued on POD 1, and pain management was switched to flurbiprofen axetil and acetaminophen. Since the NRS score remained below 2, we considered this multimodal approach to analgesia to have been effective. Additionally, Akalux® has been reported to cause significant tongue swelling and laryngeal edema postoperatively. In the presently reported case, a prophylactic tracheotomy successfully prevented airway complications after surgery. Multimodal pain management was effective for managing postoperative pain in a patient with oral cancer who underwent photoimmunotherapy.
