Evaluation of the Efficacy of Regional Anesthesia and Intramuscular Diclofenac in the Management of Postoperative Pain: A Comparative Study.

AIM: Managing postoperative pain following maxillofacial surgery is an important task. Our study aims to compare this with regional anesthesia or IM diclofenac.
MATERIALS AND METHODS: This study included 30 patients who underwent bi-jaw orthognathic surgery between April 2016 and January 2020. Two groups were formed. Group A was administered inferior alveolar nerve block at the surgical site bilaterally using 0.5% ropivacaine and Group B were administered 75 mg intramuscular diclofenac just before extubation. Tramadol HCl 2 mg/kg body wt is used as a rescue analgesic. The pain was evaluated periodically at 2nd, 4th, 6th, and 12 h postoperatively.
RESULTS: The mean Visual Analog Scale score was 2 in Group A and 5 in Group B. The mean duration of analgesia was 6 h 42 min, whereas in Group B, it was 8 h and 5 min. In 2 patients (13.3%) belonging to Group A and 3 patients (20%) belonging to Group B. There were no local complications in any group.
CONCLUSION: It was observed that regional anesthesia in the form of intraoral nerve blocks was efficient than diclofenac (75 mg) administered intramuscularly for the management of immediate postoperative pain. Copyright:

INTRODUCTION

An oral and maxillofacial surgeon performs those surgical interventions which not only protect life but also enhance the lifestyle of an individual by augmenting their esthetics and function.[1] The oral and maxillofacial region being dynamic will invariably result in severe pain in the immediate postoperative phase following surgical interventions in this region. It is a well-known fact that the successful accomplishment of any surgical intervention depends predominantly on the effective management of postoperative pain.[2] Previous studies have also revealed the same.[3] Regional anesthesia relieves the pain without causing loss of consciousness.[4] Regional anesthesia may be employed in the form of a local infiltration of an anesthetic agent at the surgical site.[5] Previous studies have shown that in the middle of the various multimodal analgesic strategies that are available for the management of immediate postoperative pain, the use of regional anesthesia has considerably amplified.[678] Therefore, this study is intended to compare regional anesthesia and dcilofenac analgesic in postoperative pain.

MATERIALS AND METHODS

Thirty patients of 18–30 years undergoing Bim jaw orthognathic surgery were included. Informed written consent was ten. Ethical clearance was obtained form Institutional Ethical Committee. All subjects were divided in Group A and B including 15 patients each. Group A were given intraoral nerve block at the surgical site using 0.5% ropivacaine just before extubation, while Group B were administered IM diclofenac 75 mg. Drug allergy and medically compromised patients were excluded from the study. The duration of surgery and analgesia was noted. Visual Analog Scale (VAS) was used to measure pain which was evaluated on 2nd, 4th, 6th, and 12th h. In VAS > 5 IM tramadol HCl 2 mg/kg body wt was given as rescue drug. The time period at which the rescue drug was administered was recorded.

RESULTS

The mean age of 30 patients was 24.2 years. Figure 1 elicits VAS for pain. In Group A, no patients had pain on 2nd postoperative h. On 4th h, 14 patients (93.33%) had no pain but one patient (6.7%) had pain with VAS > 5. On 6th h, 3 patients (20%) had pain with VAS > 5. The mean operating time for patients in the control group was 223.45 and the study group was 231.60 min [Figure 2]. The mean time to give rescue analgesia in Group A was 7 h and 15 min and patients in whom diclofenac was given intramuscularly, it required 6 h and 42 min for a rescue drug in patients receiving regional anesthesia in the form of intraoral nerve blocks (P = 0.001). Two (13.3%) patients in Group A and 3 patients (20%) in Group B required rescue analgesics, as shown in Figure 3. Complications in Group B were nausea and gastritis in 2 patients (13.3%) and 4 patients (26.6%) had pain at the injection site. However, no noticeable side effects were seen in patients receiving regional anesthesia in the form of intraoral nerve blocks. No hemodynamic changes were noticed in patients belonging to both the groups [Figure 4]. SPSS version 16 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp) was used with descriptive analysis. Chi-square test, independent sample, t-test and Mann–Whitney U-test were used for the analysis.

Figure 1

The Visual Analog Scale scores in both the groups

Figure 2

The operating time in both the groups

Figure 3

The need for rescue analgesic

Figure 4

The hemodynamic changes in both the groups

DISCUSSION

Previous studies have compared the routes of administration of analgesics and advocated that topical analgesics are useful in pain reduction.[9] Parenteral route has highest rate of action.[10] IM diclofenac or transdermal patch has good efficacy to control pain.[1112] Regional anesthesia in the form of nerve blocks is very beneficial in managing pain.[13] Thee major advantage of regional anesthesia is the elimination of pain both intraoperatively and postoperatively, especially with the use of a long-acting local anesthetic agent.[13] In addition to this, intraoral nerve blocks given in the immediate postoperative period reduce intraoperative bleeding by the action of the vasoconstrictors present in the local anesthetic solution.[13] Hence, this study employed the use of nerve block for the management of immediate postoperative pain. It was observed in this study that the VAS scores in Group A where the patient received nerve block in the immediate postoperative period were comparable Group B where the patients received intramuscular analgesics. The time at which a rescue analgesic was needed was also comparable between both the groups. This study used a conventional inferior alveolar nerve block (IANB) for pain management. A recent study has shown that the technique of Vazirani–Akinosi demonstrated superior outcomes in the form of lesser positive aspirations, rapid onset of action in addition to a better anesthetic attainment than the conventional IANB, and hence, it can be considered as an ideal replacement to the conventional IANB.[14] Regional anesthesia in the form of local infiltration or nerve blocks is safer compared to any route of drug administration. Routinely used drugs in the postoperative period like the NSAIDs and opioids can be avoided along with the adverse effects of these drugs like nausea, vomiting, and sedation, thereby reducing the patient's stay in the hospital. The fact that regional anesthesia is preferred over other routes of drug administration for the management of immediate postoperative pain is to reduce complications, reduce the drug dosage, and overall morbidity.[14] By administering nerve block in the postoperative period, a wide anatomical area can be devoid of pain in addition to the avoidance of needle pricks would be a great benefit, especially in pediatric patients.[1215] Our hemodynamic change results were in accordance with previous studies.[211] Therefore, it can be advocated that a single IANB administered just prior to extubation is sufficient as an effective pain management modality.

CONCLUSION

Regional anesthesia in the form of nerve blocks given in the immediate postoperative period eliminates pain postoperatively, especially with the use of a long-acting local anesthetic agent in addition to reduce postoperative bleeding if any by the action of the vasoconstrictors present in the local anesthetic solution. Therefore, it can be advocated that a single IANB administered just prior to extubation is sufficient to decrease the surplus analgesic need in the pain management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.