Gregor F Raschke1, Winfried Meissner2, Andre Peisker3, Gabriel Djedovic4,5, Ulrich Rieger4, Arndt Guentsch6, Marta Gomez Dammeier3, Stefan Schultze-Mosgau3. 1. Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. raschke.gregor@googlemail.com. 2. Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. 3. Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. 4. Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany. 5. Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria. 6. Marquette University School of Dentistry, Milwaukee, WI, USA.
Abstract
OBJECTIVES: Postoperative pain management is of utmost interest for patients undergoing orthognathic surgery. Currently, there is a lack of information regarding process and outcome parameters of postoperative pain management after bilateral sagittal split osteotomy. MATERIALS AND METHODS: In a prospective clinical study, 31 adults were evaluated on the first postoperative day following bilateral sagittal split osteotomy using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It allows a standardized assessment of patients' characteristics, pain parameters, outcome, and pain therapy process parameters. RESULTS: Pain management consisted mainly of premedication with midazolam, sufentanil, and metamizol intraoperatively; piritramide in the recovery room; and metamizol and tramadol on ward. Twenty patients (64.5%) showed inadequate pain management with pain levels ≥4. Patients receiving tramadol as opioid on ward presented significantly higher maximum pain levels (p = .037). Significantly lower satisfaction with postoperative pain intensity (p > .001) and significantly higher desire for additional pain medication (p = .023) were detected, when duration of surgery was above the median of 107.5 min. CONCLUSIONS: Inadequate pain management on the first postoperative day following bilateral sagittal split osteotomy was widespread on our ward. QUIPS helped us to identify it and thereby gave us the possibility to improve the situation. Prolonged duration of surgery seems to be a predictor of an elevated postoperative pain medication demand. CLINICAL RELEVANCE: Only the establishment of an ongoing monitoring of postoperative pain management can help to reduce or even avoid inadequate postoperative pain management. In accordance to the existing literature, we found inadequate postoperative pain management more widespread than thought.
OBJECTIVES:Postoperative pain management is of utmost interest for patients undergoing orthognathic surgery. Currently, there is a lack of information regarding process and outcome parameters of postoperative pain management after bilateral sagittal split osteotomy. MATERIALS AND METHODS: In a prospective clinical study, 31 adults were evaluated on the first postoperative day following bilateral sagittal split osteotomy using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It allows a standardized assessment of patients' characteristics, pain parameters, outcome, and pain therapy process parameters. RESULTS:Pain management consisted mainly of premedication with midazolam, sufentanil, and metamizol intraoperatively; piritramide in the recovery room; and metamizol and tramadol on ward. Twenty patients (64.5%) showed inadequate pain management with pain levels ≥4. Patients receiving tramadol as opioid on ward presented significantly higher maximum pain levels (p = .037). Significantly lower satisfaction with postoperative pain intensity (p > .001) and significantly higher desire for additional pain medication (p = .023) were detected, when duration of surgery was above the median of 107.5 min. CONCLUSIONS: Inadequate pain management on the first postoperative day following bilateral sagittal split osteotomy was widespread on our ward. QUIPS helped us to identify it and thereby gave us the possibility to improve the situation. Prolonged duration of surgery seems to be a predictor of an elevated postoperative pain medication demand. CLINICAL RELEVANCE: Only the establishment of an ongoing monitoring of postoperative pain management can help to reduce or even avoid inadequate postoperative pain management. In accordance to the existing literature, we found inadequate postoperative pain management more widespread than thought.
Authors: G Savoia; D Alampi; B Amantea; F Ambrosio; R Arcioni; M Berti; G Bettelli; L Bertini; M Bosco; A Casati; I Castelletti; M Carassiti; F Coluzzi; A Costantini; G Danelli; M Evangelista; G Finco; A Gatti; E Gravino; C Launo; M Loreto; R Mediati; Z Mokini; E Mondello; S Palermo; F Paoletti; A Paolicchi; F Petrini; Q Piacevoli; A Rizza; A F Sabato; E Santangelo; E Troglio; C Mattia Journal: Minerva Anestesiol Date: 2010-08 Impact factor: 3.051
Authors: Dan Benhamou; Marco Berti; Gerhard Brodner; Jose De Andres; Gaetano Draisci; Mariano Moreno-Azcoita; Edmund A M Neugebauer; Wolfgang Schwenk; Luis Miguel Torres; Eric Viel Journal: Pain Date: 2007-08-20 Impact factor: 6.961