Dento Facial Dysmorphism
Conditions
Brief summary
Background and Objectives: Double-jaw surgery is one of the most painful oral surgery, requiring multimodal analgesia including controlled morphine pump and its secondary effects. The aim of this study was to evaluate the effectiveness of face block (mandibulary and maxillary block analgesia) on the first 24 hours on morphine consumption in patients admitted for double jaw surgery.
Detailed description
Methods: Patients undergoing double-jaw surgery between January 2015 and May 2017 were enrolled. Patients were separated into 2 groups: patients receiving maxillary-mandibulary nerve block and those no receiving it. The primary endpoint was the morphine consumption within 24 hours post-surgery. Secondary endpoints were the intra-operative remifentanil consumption, incidence of postoperative nausea and vomiting at 24 hours, morphine consumption in recovery room, length of stay in hospital.
Interventions
PROCEDUREMaxillary and mandibular blocks
A Pajunk SonoPlex Stim needle 22G x 55 mm was used. For maxillary nerve block, needle was introduced next to the angle of the orbitae and the zygomatic ridge. The needle was sank until coming into contact of the temporal bone. It was then orientated to the controlateral nostril and sank of 1 cm. For mandibular block, needle was introduced in the pterygoid fossa under and perpendicularly to the zygomatic arch, and sank until the pterygoid process. The needle was then orientated towards controlateral orbitae and sank with neurostimulation. After a motor response at 0.6 milliampere (mA) and the disappearance of contraction at 0.3 mA, local mixture was injected. The mixing of local anesthesia was made of ropivacaine 5 mg/mL and clonidine 30 µg. Five mL were injected in every block for a total of 20 mL.
PROCEDUREGeneral anesthesia
Anesthesia was standardized and provided using intravenous administration of propofol and remifentanil. Patients were mechanically ventilated with a mixture of air (50/50), and desflurane or sevoflurane, or Target-controlled infusion (TCI) propofol. One to 5 mg/kg of methyl-prednisolone were administered to reduce inflammatory response.
Sponsors
Hospices Civils de Lyon
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Inclusion criteria
\- Male and female who underwent double jaw surgery
Exclusion criteria
* opposition to the study * an additional surgical procedure * preoperative consumption of morphine or derived from morphine * perioperative N20
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative morphine consumption within 24 hours post-surgery | 24 hours | Cumulative morphine consumption measured using patient controlled analgesia (PCA-pump). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Cumulative morphine consumption within 12 hours post-surgery | 12 hours | Cumulative morphine consumption measured using patient controlled analgesia (PCA-pump). |
| Peroperative remifentanil consumption | End of surgery (2 hours in average) | Remifentanil consumption in µg.kg-1 during surgery |
| Cumulative morphine consumption within 48 hours post-surgery | 48 hours | Cumulative morphine consumption measured using patient controlled analgesia (PCA-pump). |
| Hospital length of stay | Up to hospital discharge (5 days in average) | Delay between hospitalization date and date of hospital discharge |
Countries
France
Outcome results
None listed