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Grillo R, Reis BAQ, Brozoski MA, Traina AA, Melhem-Elias F. Optimizing drug regimens and supplementation in orthognathic surgery: A comprehensive and practical guide. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101639. [PMID: 37729964 DOI: 10.1016/j.jormas.2023.101639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/17/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE This study aimed to comprehensively review the literature and provide a practical guide for optimizing drug regimens and supplementation related to orthognathic surgery. METHODS The authors conducted a thorough review of the existing literature, following the PRISMA-ScR guidelines. Various types of studies except case reports and reviews were included. The study applied specific inclusion criteria, focusing on perioperative and/or postoperative drugs, medications, or supplementation related to orthognathic surgery. RESULTS This guide included 78 studies on various medications in orthognathic surgery. It encompasses clinical trials, cohort studies, cross-sectional studies, prospective and retrospective studies. The topics covered include antibiotics, analgesics, corticosteroids, antiemetics, hemostatic agents, local anesthetics, herbal medicine, and botulinum toxin. Pain and edema control involved specific medications, while local anesthesia utilized ropivacaine and bupivacaine. The guide also discusses mineral and vitamin supplementation. The effectiveness of hemostatic agents and antiemetics was highlighted. CONCLUSION Pain management, reduced swelling, enhanced wound healing, and faster recovery are among the advantages. In addition to the standard drugs and medications, the inclusion of vitamin and mineral supplements, tranexamic acid, postoperative anesthetic blocks, and preemptive antiemetics is anticipated to offer various benefits in orthognathic surgery, despite the limited available evidence.
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Affiliation(s)
- Ricardo Grillo
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo-SP, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília-DF, Brazil.
| | | | - Mariana Aparecida Brozoski
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo-SP, Brazil
| | - Andreia Aparecida Traina
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo-SP, Brazil
| | - Fernando Melhem-Elias
- Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, São Paulo-SP, Brazil; Private Practice in São Paulo-SP, Brazil
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Oono Y, Takagi S, Arendt-Nielsen L, Kohase H. Perioperative Nerve Blockade Reduces Acute Postoperative Pain after Orthognathic Surgery. Pain Res Manag 2023; 2023:7306133. [PMID: 38149075 PMCID: PMC10751169 DOI: 10.1155/2023/7306133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023]
Abstract
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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Affiliation(s)
- Yuka Oono
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Saori Takagi
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Sakado, Japan
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, SMI, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
| | - Hikaru Kohase
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences, Meikai University School of Dentistry, Sakado, Japan
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Molins G, Valls-Ontañón A, Hernández-Alfaro F, de Nadal M. Additional pre-extubation local anaesthetic application to improve the postoperative course in orthognathic surgery: a randomised controlled trial. Int J Oral Maxillofac Surg 2023; 52:1173-1178. [PMID: 37301655 DOI: 10.1016/j.ijom.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023]
Abstract
A clinical trial was performed to assess the analgesic efficacy of adding ropivacaine pre-extubation for pain management after bimaxillary osteotomy. Forty-eight patients were assigned to receive general anaesthesia followed by either a single pre-incisional infiltration with lidocaine (control group, n = 24) or the same pre-incisional infiltration with lidocaine and an additional second infiltration with ropivacaine before awakening (test group, n = 24). Postoperative pain was assessed subjectively using a visual analogue scale and objectively based on the frequency of postoperative rescue opioid consumption. The dose of opioids (methadone) consumed and frequency of postoperative-nausea-vomiting were also recorded. Patients who received the two infiltrations of local anaesthetic had better results in terms of lesser pain during the first 8 hours postoperative (P<0.001 at 2 and 4 hours; P = 0.028 at 8 h), a lesser need for rescue opioids (P = 0.020) and lower doses of rescue opioids (P = 0.011), and consequently a lesser incidence of postoperative-nausea-vomiting (0-4 hours postoperative, P<0.03). The results obtained suggest that the infiltration of an additional dose of local anaesthetic is a simple strategy for reducing pain perception and opioid use, and for ensuring greater patient comfort after bimaxillary osteotomy.
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Affiliation(s)
- G Molins
- Anestalia, Centro Médico Teknon, Barcelona, Spain.
| | - A Valls-Ontañón
- Instituto Maxilofacial, Centro Médico Teknon, Barcelona, Spain
| | | | - M de Nadal
- Department of Surgery, Universidad Autónoma de Barcelona, Hospital Valle de Hebrón, Barcelona, Spain
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Postoperative Steroid Dosing in Orthognathic Surgery, A Narrative Review of Literature. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY, MEDICINE, AND PATHOLOGY 2023. [DOI: 10.1016/j.ajoms.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Tomic J, Wallner J, Mischak I, Sendlhofer G, Zemann W, Schanbacher M, Hassanzadeh H, Sandner-Kiesling A, Payer M, Zrnc TA. Intravenous ibuprofen versus diclofenac plus orphenadrine in orthognathic surgery: a prospective, randomized, double-blind, controlled clinical study. Clin Oral Investig 2022; 26:4117-4125. [PMID: 35103836 PMCID: PMC9072507 DOI: 10.1007/s00784-022-04381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/13/2022] [Indexed: 11/26/2022]
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.
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Affiliation(s)
- Josip Tomic
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria.
| | - Jürgen Wallner
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Irene Mischak
- Department of Dental Medicine and Oral Health, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Gerald Sendlhofer
- Executive Department for Quality and Risk ManagementDivision of Plastic, Aesthetic and Reconstructive SurgeryDepartment of Surgery, Research Unit for Safety in Health, Medical University of Graz, Graz, Austria
| | - Wolfgang Zemann
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Monika Schanbacher
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Andreas Sandner-Kiesling
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Styria, Austria
| | - Michael Payer
- Department of Dental Medicine and Oral Health, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
| | - Tomislav A Zrnc
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz, Auenbruggerplatz 5, 8036, Graz, , Styria, Austria
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