Effect of chlorhexidine/benzydamine soaked pharyngeal packing on throat pain and postoperative nausea &amp; vomiting in orthognathic surgery

Vural, Çağıl; Yurttutan, Mehmet Emre; Sancak, Kevser Tütüncüler; Tüzüner, Altan

doi:10.1016/j.jcms.2019.11.014

Cited by 11 publications

(4 citation statements)

References 17 publications

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“…The use of throat packs can lead to postoperative sore throat and dysphagia [ 54 ]. Vural et al [ 55 ] used chlorhexidine/benzydamine to soak throat packs and observed reduced postoperative throat pain. However, the incidence of PONV was not statistical different when compared with saline-soaked throat packs.…”

Section: Discussionmentioning

confidence: 99%

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Gao,

Zhao,

et al. 2024

BMC Anesthesiol

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Introduction Postoperative nausea and vomiting (PONV) is one of the most common adverse events following orthognathic surgery. It’s a distressing feeling for patients and continues to be the cause of postoperative complications such as bleeding, delayed healing, and wound infection. This scoping review aims to identify effective PONV prophylaxis strategies during orthognathic surgery that have emerged in the past 15 years. Methods We searched Pubmed, Cochrane Controlled Register of Trials, and Embase from 2008 to May 2023. Studies meeting the following criteria were eligible for inclusion: (1) recruited patients undergo any orthognathic surgery; (2) evaluated any pharmacologic or non-pharmacologic method to prevent PONV. Studies meeting the following criteria were excluded: (1) case series, review papers, or retrospective studies; (2) did not report our prespecified outcomes. Results Twenty-one studies were included in this review. Pharmacological methods for PONV prevention include ondansetron and dexamethasone (3 studies), peripheral nerve block technique (4 studies), dexmedetomidine (1 study), pregabalin (2 studies), nefopam (2 studies), remifentanil (1 study), propofol (2 studies), and penehyclidine (1 study). Non-pharmacologic methods include capsicum plaster (1 study), throat packs (2 studies) and gastric aspiration (2 studies). Conclusions Based on current evidence, we conclude that prophylactic antiemetics like dexamethasone, ondansetron, and penehyclidine are the first defense against PONV. Multimodal analgesia with nerve block techniques and non-opioid analgesics should be considered due to their notable opioid-sparing and PONV preventive effect. For the non-pharmacological methods, throat packs are not recommended for routine use because of their poor effect and serious complications. More prospective RCTs are required to confirm whether gastric aspiration can prevent PONV effectively for patients undergoing orthognathic surgery.

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Section: Discussionmentioning

confidence: 99%

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Gao,

Zhao,

et al. 2024

BMC Anesthesiol

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“…A randomized, controlled research has confirmed it as a predisposing factor for postoperative aphthous stomatitis (11). Although in two studies the TP soaked with a combination of chlorhexidine gluconate and benzydamine hydrochloride (CGBH) was used to reduce sore throats, the difference did not reach statistical significance (12,13). Therefore, using TP to alleviate PONV was not recommended.…”

Section: What Is the Implication And What Should Change Now?mentioning

confidence: 99%

Suggestions on management process of throat pack in orthognathic surgery: a case report and literature review

Zhao¹,

Jiang²,

Chi³

et al. 2023

Front Oral Maxillofac Med

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Background: Throat packs are commonly used in oral surgeries to prevent accidental aspiration or ingestion. However, a forgotten throat pack can be the cause of serious postoperative complications.Although plenty of recording and warning methods have been applied, such incidents are still reported from time to time. Lack of striking marks or communication within the team is the main cause of a forgotten throat pack, and extubation before checking the number of gauzes will likely cause the throat pack to remain in the body. After literature review, quite a few related cases and precaution are available for searching, yet there is no standardized process for the use of throat pack in orthognathic surgery at present.Case Description: This article reported a case in which the throat pack was lost and retrieved relying on the good teamwork and imaging methods. The patient was a 26-year-old female undergoing bimaxillary surgery for skeletal Class III malocclusion. The throat pack was missing after wound closure. Under the guidance of maxillofacial computed tomography (CT), the throat pack was found in her right nasopharynx, the patient was extubated and recovered uneventfully.Conclusions: This paper reviewed the use of throat packs and its iatrogenic complications, summarized the experience based on this case and earlier literature, and formulated a standardized process for using a throat pack in orthognathic surgery.

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“…A total of 14 studies were included in the qualitative synthesis. Of these 14 studies, 4 had non-actionable results [4,11,40,41].…”

Section: Selection Of Studiesmentioning

confidence: 99%

“…Oral surgery itself is also a risk factor for PONV. The maxillofacial region is a highly vascularized area, and procedures involving this region can cause significant bleeding, which may increase the incidence of PONV due to intra-and postoperative blood ingestion [4]. Coughing, as a consequence of these inhalations, increases the local bleeding and can thus initiate a vicious circle.…”

Section: Introductionmentioning

confidence: 99%

Interest of pharyngeal packing in head and neck surgery: a meta-analysis

Casenave

Raynaud

Geoffroy

et al. 2023

J Oral Med Oral Surg

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Introduction: There is controversy regarding the use of pharyngeal packing in oral and nasal surgery. The primary objective of this study was to examine the association between pharyngeal packing, throat pain, and postoperative nausea and vomiting (PONV) in head and neck surgery. Material and methods: A systematic review of clinical studies published from January 2000 to August 2020 concerning the use of pharyngeal packing in head and neck surgery was conducted in the Medline, ScienceDirect and Cochrane Library databases. Throat pain and PONV were collected in each article, and a meta-analysis was performed. Results: A total of 10 clinical trials involving 877 patients were included in the meta-analysis. Pharyngeal packing did not significantly decrease PONV score either during the immediate (OR = 0.90, 95% CI: 0.59 to 1.38, p = 0.52, I2 = 0%) or the delayed postoperative period (OR = 0.88, 95% CI: 0.54 to 1.43, p = 0.28, I2 = 21%), but significantly increased the immediate postoperative throat pain score (MD = 0.68, 95% CI: 0.21 to 1.16, p = 0.19, I2 = 35%). Conclusion: This study suggests that the use of a pharyngeal packing to improve the preoperative aftermath in head and neck surgery should not be recommended.

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Effect of chlorhexidine/benzydamine soaked pharyngeal packing on throat pain and postoperative nausea & vomiting in orthognathic surgery

Cited by 11 publications

References 17 publications

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review

Suggestions on management process of throat pack in orthognathic surgery: a case report and literature review

Interest of pharyngeal packing in head and neck surgery: a meta-analysis

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