Intravenous ibuprofen versus diclofenac plus orphenadrine in orthognathic surgery: a prospective, randomized, double-blind, controlled clinical study

Abstract

Objectives The aim of this prospective, randomized, double-blind, controlled clinical study was to evaluate the analgesic effect of ibuprofen versus diclofenac plus orphenadrine on postoperative pain in orthognathic surgery. Material and methods Patients who underwent orthognathic surgery were randomized into two groups to receive intravenously either 600 mg of ibuprofen (I-group) or 75 mg diclofenac plus 30 mg orphenadrine (D-group), both of which were given twice daily. Additionally, both groups were given metamizole 500 mg. Rescue pain medication consisted of acetaminophen 1000 mg and piritramide 7.5 mg as needed. To assess the pain intensity, the primary end point was the numeric rating scale (NRS) recorded over the course of the hospital stay three times daily for 3 days. Results One hundred nine patients were enrolled (age range, 18 to 61 years) between May 2019 and November 2020. Forty-eight bilateral sagittal split osteotomies (BSSO) and 51 bimaxillary osteotomies (BIMAX) were performed. Surgical subgroup analysis found a significant higher mean NRS (2.73 vs.1.23) in the BIMAX D-group vs. I-group (p = 0.015) on the third postoperative day. Additionally, as the patient’s body mass index (BMI) increased, the mean NRS (r = 0.517, p = 0.001) also increased. No differences were found between age, gender, length of hospital stay, weight, operating times, number of patients with complete pain relief, acetaminophen or piritramide intake, and NRS values. No adverse events were observed. Conclusion The results of this study demonstrate that ibuprofen administration and lower BMI were associated with less pain for patients who underwent bimaxillary osteotomy on the third postoperative day. Therefore, surgeons may prefer ibuprofen for more effective pain relief after orthognathic surgery. Clinical relevance Ibuprofen differs from diclofenac plus orphenadrine in class and is a powerful analgetic after orthognathic surgery.

Use of Muscle Relaxants for Acute Postoperative Pain: A Practical Review

“…They found no significant difference between the sides of the mouth for pain, swelling, or trismus in the first 48 hours. Tomic et al 38 compared the analgesic effects of intraoperative and postoperative administration of intravenous orphenadrine and diclofenac with ibuprofen alone in patients undergoing orthognathic surgery and found no significant difference in pain intensity.…”

Comparing the effects of pre-emptive oxycodone, diclofenac, and gabapentin on postoperative pain after tibia fracture surgery: A randomized clinical trail

“…Moreover, Tomic et al . [ 18 ] showed that diclofenac, as an adjacent to orphenadrine, was effective in significantly reducing POP. Similarly, Yuri et al .…”

Photobiomodulation using 940‐nm laser as an adjuvant therapy on orthognathic surgery: A randomized clinical trial

“…(trismus), paresthesia, and so on [5]. To minimize symptoms and accelerate patient recovery, some pharmacological and nonpharmacological protocols have been extensively studied and used, such as cryotherapy, anti-inflammatory and analgesics, kinesiotaping, lymphatic drainage, vitamin complex supplementation, electroacupuncture, photobiomodulation (PBM) therapy, and so on [6][7][8][9][10][11][12].…”

“…However, regardless of the technology used, good surgical technical skills, reduced surgical time, and appropriate management of the oral mucosa and facial tissues, some unwanted postoperative symptoms are expected, such as pain, edema, limited mouth opening (trismus), paresthesia, and so on [5]. To minimize symptoms and accelerate patient recovery, some pharmacological and nonpharmacological protocols have been extensively studied and used, such as cryotherapy, anti‐inflammatory and analgesics, kinesiotaping, lymphatic drainage, vitamin complex supplementation, electroacupuncture, photobiomodulation (PBM) therapy, and so on [6–12].…”