Postoperative Pain Management Using Supplemental Bupivacaine After Mandibular Orthognathic Surgery: A Triple-Blind Randomized Controlled Clinical Trial

Kc, Kumar; Arunakul, Kanin; Apipan, Benjamas; Rummasak, Duangdee; Kiattavorncharoen, Sirichai; Shrestha, Manash

doi:10.1016/j.joms.2021.08.003

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…A recent randomized controlled clinical trial showed that postoperative bupivacaine use did not show superior analgesic efficacy when compared with normal saline in controlling acute POP after bilateral SSRO [ 24 ]. The duration of action for 0.5% levobupivacaine hydrochloride is approximately 6 h [ 25 ], and the elimination half-life for bupivacaine hydrochloride hydrate is also approximately 6 h [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative Nerve Blockade Reduces Acute Postoperative Pain after Orthognathic Surgery

Oono,

Takagi,

Arendt-Nielsen

et al. 2023

Pain Research and Management

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Background. The role of perioperative pain management is not only to reduce acute postoperative pain (POP) but also to prevent chronic POP. It would be important to know the usefulness of nerve blockade for perioperative management. However, it has not been extensively studied in orofacial surgery. The objective of the study was to investigate whether perioperative nerve blockade reduces acute POP after orthognathic surgery. Methods. Patients scheduled for orthognathic surgery were retrospectively reviewed (“preblock group”: the nerve blockade was performed before emergence from general anesthesia, and “no preblock group”: the nerve blockade was not performed before emergence from general anesthesia). The visual analog scale (VAS; 0–100 mm)-POP intensity, the VAS-POP areas under the curves (VASAUCs (mm × day)) in addition to VASAUCs for postoperative hours 6 (VASAUC_6), 12 (VASAUC_12), 18 (VASAUC_18), and 24 (VASAUC_24), the analgesic requirement period (day), and the number of days with pain (day) were analyzed. Data are presented as median (interquartile range) values. Results. Fifty-six patients (preblock group, 22; no preblock group, 34) were included (21 males, 35 females; age: 22.0 [21.0–28.0] years). VASAUC_6, VASAUC_12, VASAUC_18, and VASAUC_24 in the preblock group were significantly smaller than those in the no preblock group (3.5 [2.0–7.2] vs. 7.4 [5.1–10.0], p = 0.0007; 9.5 [6.4–13.7] vs. 15.0 [7.2–22.9], p = 0.042; 15.7 [10.3–23.1] vs. 29.3 [18.9–37.2], p = 0.0002; and 17.6 [12.7–27.2] vs. 39.5 [22.9–46.9], p = 0.001, respectively). There were no significant differences between the 2 groups in VASAUC, the analgesic requirement period, and the number of days with pain ( p > 0.05). Conclusions. Perioperative nerve blockade reduces POP after orthognathic surgery, especially for the acute postoperative period.

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Section: Discussionmentioning

confidence: 99%

Perioperative Nerve Blockade Reduces Acute Postoperative Pain after Orthognathic Surgery

Oono,

Takagi,

Arendt-Nielsen

et al. 2023

Pain Research and Management

View full text Add to dashboard Cite

show abstract

“…Following orthognathic surgery, NSAIDs are the most commonly prescribed medication for postoperative pain medications [17]; however, the lack of evidence regarding pain management in oral and maxillofacial surgery results in wide variations in analgesic practice. [18,20,20] Of importance, a consensus has emerged in cardiovascular pharmacotherapy regarding diclofenac, noting it has the potential for higher rates of cardiovascular side effects. [24] The European Medical Agency has released two Pharmacovigilance Risk Assessment Committee (PRAC) recommendations on diclofenac (2013) and ibuprofen ( 2016) to increase awareness of potential cardio-or cerebrovascular side effects while still confirming that both drugs are valuable analgesics in the appropriate patients [21,22].…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, the authors found no adverse events from metamizole. [18,20,21,22,23] A review and position paper by the working group for Cardiovascular Pharmacotherapy of the European Society of Cardiology, the number needed to harm for diclofenac, because of a serious cardiovascular events, was 25. [25] For example, a low NNH indicates that one is more likely to encounter the harm than the benefit, as a serious adverse event is encountered after treating just 25 patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Postoperative steroid dosing in orthognathic surgery: A narrative review of literature

Gupta

Waknis

2023

Journal of Oral and Maxillofacial Surgery, Medicine, and Pathol

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Postoperative Pain Management Using Supplemental Bupivacaine After Mandibular Orthognathic Surgery: A Triple-Blind Randomized Controlled Clinical Trial

Cited by 6 publications

References 25 publications

Perioperative Nerve Blockade Reduces Acute Postoperative Pain after Orthognathic Surgery

Perioperative Nerve Blockade Reduces Acute Postoperative Pain after Orthognathic Surgery

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

Postoperative steroid dosing in orthognathic surgery: A narrative review of literature

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