Vikram Shetty1, Bylapudi BhanuPrakash2, Anirudh Yadav3, Nanda Kishore P4, Akash Menon5. 1. Director, Nitte Meenakshi Institute of Craniofacial Surgery, K.S. Hegde Hospital; and Professor and Head, Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, India. 2. Resident, Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, India. 3. Surgical Fellow, Nitte Meenakshi Institute of Craniofacial Surgery, K.S. Hegde Hospital; and Lecturer, Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, India. 4. Head, Department of Craniofacial Orthodontics, and Professor, Department of Orthodontics and Dentofacial Orthopaedics, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, India. 5. Surgical Fellow, Nitte Meenakshi Institute of Craniofacial Surgery, K.S. Hegde Hospital; and Lecturer, Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Mangalore, India. Electronic address: drakashmenon@gmail.com.
Abstract
PURPOSE: Any elective surgery should be as atraumatic to the patient as possible to allow for a comfortable postoperative recovery. The present study was performed to evaluate the efficacy of preoperative regional blocks in reducing pain, discomfort, and analgesic use in patients scheduled to undergo bimaxillary surgery. PATIENTS AND METHODS: A prospective, double-blind, randomized controlled trial was conducted to include all patients aged 16 to 30 years requiring bimaxillary surgery. We excluded patients with syndromes and systemic conditions. The primary predictor variable was the maxillary and mandibular nerve blocks (extraoral lateral pterygoid method) administered preoperatively in the operating room using 0.25% bupivacaine hydrochloride. Standard anesthetic and postoperative protocols were followed. The primary outcome variable was postoperative pain. The secondary outcome variables were postoperative discomfort, analgesic consumption, duration of surgery, and blood loss. The unpaired t test and Mann-Whitney U test were used for statistical analyses, with P < .05 considered to indicate statistical significance. RESULTS:A total of 110 patients were included in the study (55 in the control group and 55 in the test group), of whom 61 were female and 49 were male. Postoperative pain, recorded using a visual analog scale was significantly lower (P < .001) in the test group compared with the control group. Secondary outcome variables such as postoperative discomfort and analgesic consumption were also significantly lower in the test group. A significant positive correlation was present between the duration of surgery and pain measured at 6, 12, 24, and 48 hours postoperatively in both groups. CONCLUSIONS: From our results, it can be established that the administration of preoperative regional blocks using 0.25% bupivacaine immediately before bimaxillary surgery can effectively minimize patients' postoperative pain, discomfort, and consumption of analgesics.
RCT Entities:
PURPOSE: Any elective surgery should be as atraumatic to the patient as possible to allow for a comfortable postoperative recovery. The present study was performed to evaluate the efficacy of preoperative regional blocks in reducing pain, discomfort, and analgesic use in patients scheduled to undergo bimaxillary surgery. PATIENTS AND METHODS: A prospective, double-blind, randomized controlled trial was conducted to include all patients aged 16 to 30 years requiring bimaxillary surgery. We excluded patients with syndromes and systemic conditions. The primary predictor variable was the maxillary and mandibular nerve blocks (extraoral lateral pterygoid method) administered preoperatively in the operating room using 0.25% bupivacaine hydrochloride. Standard anesthetic and postoperative protocols were followed. The primary outcome variable was postoperative pain. The secondary outcome variables were postoperative discomfort, analgesic consumption, duration of surgery, and blood loss. The unpaired t test and Mann-Whitney U test were used for statistical analyses, with P < .05 considered to indicate statistical significance. RESULTS: A total of 110 patients were included in the study (55 in the control group and 55 in the test group), of whom 61 were female and 49 were male. Postoperative pain, recorded using a visual analog scale was significantly lower (P < .001) in the test group compared with the control group. Secondary outcome variables such as postoperative discomfort and analgesic consumption were also significantly lower in the test group. A significant positive correlation was present between the duration of surgery and pain measured at 6, 12, 24, and 48 hours postoperatively in both groups. CONCLUSIONS: From our results, it can be established that the administration of preoperative regional blocks using 0.25% bupivacaine immediately before bimaxillary surgery can effectively minimize patients' postoperative pain, discomfort, and consumption of analgesics.