Predictors of pain and prolonged length of stay after orthognathic surgery: A retrospective cohort study
Keywords:
Orthognathic surgery, Pain postoperative, Anesthesia, Length of stay, Pain
Abstract
Introduction: Orthognathic treatment has assumed an important role in orthodontics and maxillofacial surgery in the last years; however, little has been investigated about this type of treatment.
Objectives: The main purpose of this study was to identify major factors and/or predictors associated with postoperative pain (PP) and hospital length of stay (LOS) after orthognathic surgery.
Materials and methods: 52 patients who underwent orthognathic surgery from 2008 to 2010 at the University Hospital of São Paulo University were investigated. Study variables such as patient characteristics, preoperative, intraoperative and postoperative data were collected. The outcome variables were PP and LOS. Descriptive and analytical statistics was computed for all variables.
Results: 27.6% of patients had pain in the postoperative period. Lidocaine used in general anesthesia was an associated factor of PP. The overall mean LOS was 2 days; gender, location of procedure, type and duration of anesthesia were identified as probable predisposing factors. There was a significant correlation between anesthesia time and discharge. Anesthesia variables were more predictably related with postoperative pain and hospitalization time. Location of orthognathic procedure, however, was an important surgical variable that influenced in LOS.
Conclusions: Intravenous lidocaine boluses used during general anesthesia were associated with PP. Male patients, single-jaw surgery, inhalational anesthesia and duration of anesthesia were predisposing factors that improve LOS.
References
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27. Van Strijen PJ, Breuning KH, Becking AG, Perdijk FB, Tuinzing DB. Cost, operation and hospitalization times in distraction osteogenesis versus sagittal split osteotomy. J Craniomaxillofac Surg. 2003;31:42-5.
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30. Gupta A, Stierer T, Zuckerman R, Sakima N, Parker SD, Fleisher LA. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg. 2004;98:632-41.
31. Méndez NG, Ramírez PAG, Pineda MMC, Picazo CR. Anesthetic considerations for orthognathic surgery: clinical case report. Rev Colomb Anestesiol. 2013;41:69-74.
32. Peacock ZS, Lee CCY, Klein KP, Kaban LB. Orthognathic surgery in patients over 40 years of age: indications and special considerations. J Oral Maxillofac Surg. 2014;72: 1995-2004.
2. Moles DR, Cunningham SJ. A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period: Part 1 - Service factors. Br J Oral Maxillofac Surg. 2009;47:268-73.
3. Huamán ET, Juvet LM, Nastri A, Denman WT, Kaban LB, Dodson TB. Changing patterns of hospital length of stay after orthognathic surgery. J Oral Maxillofac Surg. 2008;66:492-7.
4. Grando TA. Hipotensão arterial induzida. In: Cangiani LM, Slullitel A, Potério GMB, Pires OC, Posso IP, Nogueira CS, et al., editors. Tratado de Anestesiologia - SAESP. 7th ed. São Paulo: Atheneu; 2011. p. 905.
5. White PF, Eng MR. Ambulatory (outpatient) anesthesia. In: Miller RD, editor. Anesthesia. 7th ed. Philadelphia: Churchill Livingstone Inc.; 2010. p. 2419.
6. Lupori JP, Van Sickels JE, Holmgreen WC. Outpatient orthognathic surgery: review of 205 cases. J Oral Maxillofac Surg. 1997;55:558-63.
7. Blakey GH 3rd, White RP Jr. Bilateral sagittal split osteotomies in an ambulatory care setting. Semin Orthod. 1999;5:241-3.
8. Choi WS, Samman N. Risks and benefits of deliberate hypotension in anaesthesia: a systematic review. Int J Oral Maxillofac Surg. 2008;67:687-703.
9. Lanigan DT, Hey J, West RA. Hemorrhage following mandibular osteotomies: a report of 21 cases. J Oral Maxillofac Surg. 1991;49:713-24.
10. Faverani LP, Ferreira GR, Fabris ALS, Polo TOB, Poli GHS, Pastori CM, et al. Intraoperative blood loss and blood transfusion requirements in patients undergoing orthognathic surgery. Oral Maxillofac Surg. 2014;18:305-10.
11. Ueki K, Manukawa K, Shimada M, Nakagawa K, Yamamoto E. The assessment of blood loss in orthognathic surgery for prognathia. J Oral Maxillofac Surg. 2005;63:350-4.
12. Zellin G, Rasmusson L, Palsson J, Kahnberg KE. Evaluation of hemorrhage depressors on blood loss during orthognathic surgery: a retrospective study. J Oral Maxillofac Surg. 2004;62:662-6.
13. Panula K, Finne K, Oikarinen K. Incidence of complications and problems related to orthognathic surgery: a review of 655 patients. J Oral Maxillofac Surg. 2001;59:1128-36.
14. Niederhagen B, Braumann B, Dierke-Dzierzon C, Albrecht S. Postoperative pain after interventions in the area of the mouth-jaw-face. Mund Kiefer Gesichtschir. 1997;1:229-34.
15. Couceiro TCM, Valença MM, Lima LC, Menezes TC, Raposo MCF. Prevalência e influência do sexo, idade e tipo de operação na dor pós-operatória. Rev Bras Anestesiol. 2009;59:314-20.
16. Bryson GL, Charapov I, Krolczyk G, Taljaard M, Reid D. Intravenous lidocaine does not reduce length of hospital stay following abdominal hysterectomy. Can J Anaesth. 2010;57:759-66.
17. Wuethrich PY, Romero J, Burkhard FC, Curatolo M. No benefit from intravenous lidocaine in laparoscopy renal surgery: a randomised, placebo-controlled study. Eur J Anaesthesiol. 2012;29:537-43.
18. McCarthy GC, Megalla SA, Habib AS. Impact of intravenous lidocaine infusion on postoperative analgesia and recovery from surgery: a systematic review of randomized controlled trials. Drugs. 2010;70:1149-63.
19. De Oliveira GS Jr, Fitzgerald P, Streicher LF, Marcus RJ, McCarthy RJ. Systemic lidocaine to improve postoperative quality of recovery after ambulatory laparoscopic surgery. Anesth Analg. 2012;115:262-7.
20. Clarke C, McConachie I, Banner R. Lidocaine infusion as a rescue analgesic in the perioperative setting. Pain Res Manag. 2008;13:421-3.
21. Koppert W, Weigand M, Neumann F, Sittl R, Schuettler J, Schmelz M, et al. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg. 2004;98:1050-5.
22. Vigneault L, Turgeon AF, Côté D, Lauzier F, Zarychanski R, Moore L, et al. Perioperative intravenous lidocaine infusion for postoperative pain control: a meta-analysis of randomized controlled trials. Can J Anaesth. 2011;58:22-37.
23. Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg. 2008;95:1331-8.
24. Tornes K, Lyberg T. Surgical correction of mandibular prognathism in Norway, 1975-1984. A national survey. Acta Odontol Scand. 1987;45:87-94.
25. Knoff SB, Van Sickels JE, Holmgreen WC. Outpatient orthognathic surgery: criteria and a review of cases. J Oral Maxillofac Surg. 1991;49:117-20.
26. Lombardo GA, Karakourtis MH, White RP Jr. The impact of clinical practice patterns on hospital charges for orthognathic surgery. Int J Adult Orthodon Orthognath Surg. 1994;9:251-6.
27. Van Strijen PJ, Breuning KH, Becking AG, Perdijk FB, Tuinzing DB. Cost, operation and hospitalization times in distraction osteogenesis versus sagittal split osteotomy. J Craniomaxillofac Surg. 2003;31:42-5.
28. DATASUS. SUS hospitalar procedures - public database [online]. http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sih/cnv/qruf.def [accessed 10.05.12] .
29. Ganem EM, Vianna PTG, Fabris P, Moro M, Nascimento P, Castiglia YMM. Comparação da recuperação de anestesia venosa com propofol e anestesia inalatória com sevoflurano para laparoscopia ginecológica. Rev Bras Anestesiol. 1999;49:84-8.
30. Gupta A, Stierer T, Zuckerman R, Sakima N, Parker SD, Fleisher LA. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane and desflurane: a systematic review. Anesth Analg. 2004;98:632-41.
31. Méndez NG, Ramírez PAG, Pineda MMC, Picazo CR. Anesthetic considerations for orthognathic surgery: clinical case report. Rev Colomb Anestesiol. 2013;41:69-74.
32. Peacock ZS, Lee CCY, Klein KP, Kaban LB. Orthognathic surgery in patients over 40 years of age: indications and special considerations. J Oral Maxillofac Surg. 2014;72: 1995-2004.
How to Cite
1.
Shinagawa A, Melhem FE, de Campos AC, Dias Cicarelli D, Frerichs E. Predictors of pain and prolonged length of stay after orthognathic surgery: A retrospective cohort study. Colomb. J. Anesthesiol. [Internet]. 2015 Apr. 1 [cited 2024 Apr. 19];43(2):129-35. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/431
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Published
2015-04-01
How to Cite
1.
Shinagawa A, Melhem FE, de Campos AC, Dias Cicarelli D, Frerichs E. Predictors of pain and prolonged length of stay after orthognathic surgery: A retrospective cohort study. Colomb. J. Anesthesiol. [Internet]. 2015 Apr. 1 [cited 2024 Apr. 19];43(2):129-35. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/431
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