Orthognathic surgery affecting the jaws and face requires a balancing act in anesthetic technique. Factors such as limiting blood loss, avoiding respiratory depression, and averting postoperative nausea and vomiting can lead to optimal patient outcomes. The use of the drugs such as propofol and remifentanil is increasing because the drugs can meet these needs; however, with the use of these drugs patients may subsequently experience more postoperative pain.
In the Summer 2012 issue of the journal Anesthesia Progress, an article by Dr. Soudeh Chegini et al presents a retrospective study of 51 patients in a single medical center. The patients were divided into 2 groups. There were 21 orthognathic maxillofacial surgery patients in the group who received intravenous propofol and remifentanil; these patients experienced significantly higher pain scores. Anesthesia for the 30 patients in the comparison group was maintained with inhalational agents and longer-acting opioids. The drug remifentanil is seeing increased use in orthognathic surgery because its short half-life can facilitate stable operating conditions while avoiding the undesirable postoperative consequences of morphine and other such agents.
There is still a need for pain control in the postoperative period using longer-acting opioids that carry a greater potential for adverse effects. The study was undertaken to ensure that achieving better intraoperative conditions did not come at the expense of patients’ recovery. Variables of comparison included recovery time, occurrence of nausea and vomiting, pain scores, heart rate, and opioid dose administered in the 4 hours following surgery. There was a trend toward shorter recovery times in the group receiving propofol and remifentanil. The median recovery time was 65 minutes for this group, and the recovery time was 93 minutes for the inhalation group. However, the study found that for the first group of patients who received the propofol and remifentanil, there were higher pain scores reported in the first 4 hours following surgery. No differences were found in early postoperative opioid use, heart rate, or nausea and vomiting. With maxillofacial surgery, it is known that postoperative respiratory and gastrointestinal complications can be dangerous.
While turning to drugs that can re-duce these risks leads to better surgical experiences, it may also mean increased postoperative pain for patients. This study takes a first look at this occurrence and may be the stimulus for future controlled studies.

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(Source: Chegini S et al. The effect of anesthetic technique on recovery after orthognathic surgery: a retrospective audit. Anesthesia Progress, Summer 2012, Volume 59, Number 2, pages 69 to 74)

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