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Bilateral sagittal split osteotomy-parameters and correlations of postoperative pain management

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Abstract

Objectives

Postoperative pain management is of utmost interest for patients undergoing orthognathic surgery. Currently, there is a lack of information regarding process and outcome parameters of postoperative pain management after bilateral sagittal split osteotomy.

Materials and methods

In a prospective clinical study, 31 adults were evaluated on the first postoperative day following bilateral sagittal split osteotomy using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It allows a standardized assessment of patients’ characteristics, pain parameters, outcome, and pain therapy process parameters.

Results

Pain management consisted mainly of premedication with midazolam, sufentanil, and metamizol intraoperatively; piritramide in the recovery room; and metamizol and tramadol on ward. Twenty patients (64.5%) showed inadequate pain management with pain levels ≥4. Patients receiving tramadol as opioid on ward presented significantly higher maximum pain levels (p = .037). Significantly lower satisfaction with postoperative pain intensity (p > .001) and significantly higher desire for additional pain medication (p = .023) were detected, when duration of surgery was above the median of 107.5 min.

Conclusions

Inadequate pain management on the first postoperative day following bilateral sagittal split osteotomy was widespread on our ward. QUIPS helped us to identify it and thereby gave us the possibility to improve the situation. Prolonged duration of surgery seems to be a predictor of an elevated postoperative pain medication demand.

Clinical relevance

Only the establishment of an ongoing monitoring of postoperative pain management can help to reduce or even avoid inadequate postoperative pain management. In accordance to the existing literature, we found inadequate postoperative pain management more widespread than thought.

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Author information

Authors and Affiliations

  1. Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Gregor F. Raschke, Andre Peisker, Marta Gomez Dammeier & Stefan Schultze-Mosgau

  2. Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany

    Winfried Meissner

  3. Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany

    Gabriel Djedovic & Ulrich Rieger

  4. Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria

    Gabriel Djedovic

  5. Marquette University School of Dentistry, Milwaukee, WI, USA

    Arndt Guentsch

Authors
  1. Gregor F. Raschke
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  2. Winfried Meissner
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  3. Andre Peisker
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  4. Gabriel Djedovic
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  5. Ulrich Rieger
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  7. Marta Gomez Dammeier
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Correspondence to Gregor F. Raschke.

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The authors declare that they have no conflict of interest.

Funding

There were no sources of funding.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Prior to study start, the local ethics committee of the University Jena gave its approval. All patients willing to participate gave their consent.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Raschke, G.F., Meissner, W., Peisker, A. et al. Bilateral sagittal split osteotomy-parameters and correlations of postoperative pain management. Clin Oral Invest 22, 181–187 (2018). https://doi.org/10.1007/s00784-017-2097-z

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  • DOI: https://doi.org/10.1007/s00784-017-2097-z

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