The Effect of Anesthetic Technique on Recovery After Orthognathic Surgery: A Retrospective Audit

Abstract

We audited the recovery characteristics of 51 patients who had undergone orthognathic maxillofacial surgery at a single center. Patients whose anesthesia had been maintained with intravenous propofol and remifentanil (n 5 21) had significantly higher pain scores during the first 4 hours after surgery than those whose anesthesia was maintained with volatile inhalational agents and longer-acting opioids (n 5 30) (P 5 .016). There was a nonsignificant trend towards shorter recovery times in the former group, while there were no differences in early postoperative opioid usage, hemodynamic parameters, or postoperative nausea and vomiting . Given that our data were collected retrospectively and without the ability to control for potential confounders, we interpret the results with caution. Notwithstanding these limitations, we believe this is the first report comparing the effects of different opioid-based anesthetic regimens on early recovery from orthognathic surgery, and we believe this report may be used as the starting point for a controlled study.

Multimodal Protocol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Le Fort I Osteotomy

“…7,36,37 Farah et al examined two regimens to achieve deliberate hypotension in just 20 orthognathic surgery patients and concluded that, in contrast to prior studies, those subjects anesthetized without the use of a volatile agent experienced more PON than those managed with a volatile anesthetic. However, though they report a 40% prevalence of PON in those managed without a volatile agent, they also describe a more alarming 40% prevalence of PO V in those who received volatile anesthetic.…”

“…There was a nonsignificant trend towards more PONV in the first four hours after surgery in the group receiving a TIVA (14%) than in the group receiving a volatile agent (10%). 37 …”

Factors that Affect Intravenous Patient-Controlled Analgesia for Postoperative Pain Following Orthognathic Surgery for Mandibular Prognathism

“…The recovery of psychomotor function after total intravenous anesthesia (TIVA) with remifentanil, which does not use any inhalational agents, was 30–120 min faster than TIVA with fentanyl [19]. Orthognathic patients who were maintained with TIVA with remifentanil had significantly higher pain scores within the first 4 h postoperatively [20]. Thus, the groups that were maintained with remifentanil (i.e., the F-R and R-R groups) may recognize postoperative pain father than the group that was maintained with fentanyl (i.e., the F-F group).…”

Anaesthesia for cosmetic and functional maxillofacial surgery

“…Long-acting opioids must still be administered at the end of the case if they have not been used throughout, and the risks of opioid-induced respiratory depression and other adverse effects are not negated. Limited retrospective data suggest that there is also the potential for postoperative pain scores to be higher in patients managed with remifentanil compared with those managed intra-operatively with long-acting opioids 5 and this should be kept in mind. The early use of nerve blocks may help avoid this potential disadvantage.…”

“…Intra-operative steroids, usually dexamethasone, are administered primarily to minimize postoperative swelling but are also efficacious anti-emetics and contribute to analgesia. Orthognathic surgery is nevertheless associated with a high incidence of postoperative nausea and vomiting (PONV) of 7 -40% even with peri-operative steroids, 5 the occurrence of which is undesirable in these patients, particularly if jaw fixation is to be used after operation in some form (see below). The use of additional anti-emetics should be considered.…”