Orthognathic Surgery and Recovery Have Different Anesthetic Requirements

Patients who had had anesthesia maintained with propofol and remifentanil (P&R) during orthognathic surgery had significantly higher pain scores afterwards, according to a new study.

Researchers at The John Radcliffe Hospital (Oxford, United Kingdom) and Heatherwood and Wexham Park Hospitals NHS Foundation Trust (United Kingdom) conducted a retrospective study of 51 patients to ensure that good intraoperative anesthetic conditions with P&R are not being achieved at the expense of detrimental recovery characteristics. The study involved 21 orthognathic maxillofacial surgery patients who received intravenous P&R, while anesthesia for the 30 patients in the control group was maintained with inhalational agents and opioids.

The researchers found that patients whose anesthesia had been maintained with intravenous P&R had significantly higher pain scores during the first four hours after surgery than those whose anesthesia was maintained with volatile inhalational agents and longer-acting opioids. There was a nonsignificant trend towards shorter recovery times in the former group, while there were no differences in early postoperative opioid usage, hemodynamic parameters, or postoperative nausea and vomiting .

“With maxillofacial surgery, postoperative respiratory and gastrointestinal complications can be dangerous. While turning to drugs that can reduce these risks leads to better surgical experiences, it may also mean increased postoperative pain for patients,” concluded lead author Soudeh Chegini, MD, of the Heatherwood and Wexham Park Hospitals. “We believe this is the first report comparing the effects of different opioid-based anesthetic regimens on early recovery from orthognathic surgery, and we believe this report may be used as the starting point for a controlled study.”

Anesthetic maintenance with P&R is fast becoming the technique of choice for orthognathic surgery, since it is perceived that the very short half-life of the latter allows stable hypotensive conditions intraoperatively, and a rapid return of respiratory function postoperatively. However, the short half-life of remifentanil means that longer-acting opioids must still be administered at the end of surgery. The risk of respiratory depression from opioid overdose, pain from underdosing, and postoperative nausea and vomiting (PONV) are therefore not eliminated.

Related Links:
The John Radcliffe Hospital
Heatherwood and Wexham Park Hospitals NHS Foundation Trust