Perioperative Nerve Blockade Reduces Acute Postoperative Pain after Orthognathic Surgery

Yuka Oono, Saori Takagi, Lars Arendt-Nielsen, Hikaru Kohase
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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],  = 0.0007; 9.5 [6.4–13.7] vs. 15.0 [7.2–22.9],  = 0.042; 15.7 [10.3–23.1] vs. 29.3 [18.9–37.2],  = 0.0002; and 17.6 [12.7–27.2] vs. 39.5 [22.9–46.9],  = 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 ( > 0.05). Conclusions. Perioperative nerve blockade reduces POP after orthognathic surgery, especially for the acute postoperative period.
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围手术期神经阻滞可减轻正颌外科手术后的急性疼痛
背景。围手术期疼痛管理的作用不仅在于减轻急性术后疼痛(POP),还在于预防慢性术后疼痛。了解神经阻滞在围手术期疼痛治疗中的作用非常重要。然而,口腔外科尚未对此进行广泛研究。本研究旨在探讨围手术期神经阻滞是否能减轻正颌手术后的急性 POP。研究方法对计划接受正颌手术的患者进行回顾性研究("预阻滞组":在全身麻醉苏醒前进行神经阻滞;"无预阻滞组":在全身麻醉苏醒前不进行神经阻滞)。除了术后 6 小时(VASAUC_6)、12 小时(VASAUC_12)、18 小时(VASAUC_18)和 24 小时(VASAUC_24)的 VASAUC 外,还分析了视觉模拟量表(VAS;0-100 毫米)-POP 强度、VAS-POP 曲线下面积(VASAUC(毫米×天))、镇痛剂需求时间(天)和疼痛天数(天)。数据以中位数(四分位数间距)值表示。结果共纳入 56 名患者(预阻滞组,22 人;无预阻滞组,34 人)(男性 21 人,女性 35 人;年龄:22.0 [21.0-28.0] 岁)。预阻断组的 VASAUC_6、VASAUC_12、VASAUC_18 和 VASAUC_24 显著小于无预阻断组(3.5 [2.0-7.2] vs. 7.4 [5.1-10.0], = 0.0007; 9.5 [6.4-13.7] vs. 15.0 [7.2-22.9],=0.042;15.7 [10.3-23.1] vs. 29.3 [18.9-37.2],=0.0002;17.6 [12.7-27.2] vs. 39.5 [22.9-46.9],=0.001)。两组在 VASAUC、镇痛剂需求期和疼痛天数上没有明显差异 ( > 0.05)。结论围手术期神经阻滞可减少正颌手术后的持久性有机污染物,尤其是术后急性期。
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