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

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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References

  1. 1.

    Kehlet H (2004) Effect of postoperative pain treatment on outcome-current status and future strategies. Langenbeck’s Arch Surg 389:244–249. doi:10.1007/s00423-004-0460-4

    Article  Google Scholar 

  2. 2.

    Wittekindt D, Wittekindt C, Meissner W, Guntinas-Lichius O (2012) Postoperative pain assessment after middle ear surgery. HNO 60:974–984. doi:10.1007/s00106-012-2556-4

    Article  PubMed  Google Scholar 

  3. 3.

    Savoia G, Alampi D, Amantea B, Ambrosio F, Arcioni R, Berti M, Bettelli G, Bertini L, Bosco M, Casati A, Castelletti I, Carassiti M, Coluzzi F, Costantini A, Danelli G, Evangelista M, Finco G, Gatti A, Gravino E, Launo C, Loreto M, Mediati R, Mokini Z, Mondello E, Palermo S, Paoletti F, Paolicchi A, Petrini F, Piacevoli Q, Rizza A, Sabato AF, Santangelo E, Troglio E, Mattia C (2010) Postoperative pain treatment SIAARTI recommendations 2010. Short version. Minerva Anestesiol 76:657–667

    PubMed  Google Scholar 

  4. 4.

    Fries BE, Simon SE, Morris JN, Flodstrom C, Bookstein FL (2001) Pain in U.S. nursing homes: validating a pain scale for the minimum data set. Gerontologist 41:173–179

    Article  PubMed  Google Scholar 

  5. 5.

    Gureje O, Simon GE, Von Korff M (2001) A cross-national study of the course of persistent pain in primary care. Pain 92:195–200

    Article  PubMed  Google Scholar 

  6. 6.

    Warfield CA, Kahn CH (1995) Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology 83:1090–1094

    Article  PubMed  Google Scholar 

  7. 7.

    Fletcher D, Fermanian C, Mardaye A, Aegerter P (2008) A patient-based national survey on postoperative pain management in France reveals significant achievements and persistent challenges. Pain 137:441–451. doi:10.1016/j.pain.2008.02.026

    Article  PubMed  Google Scholar 

  8. 8.

    Apfelbaum JL, Chen C, Mehta SS, Gan TJ (2003) Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 97:534–540 table of contents

    Article  PubMed  Google Scholar 

  9. 9.

    Gordon DB, Dahl JL, Miaskowski C, McCarberg B, Todd KH, Paice JA, Lipman AG, Bookbinder M, Sanders SH, Turk DC, Carr DB (2005) American pain society recommendations for improving the quality of acute and cancer pain management: American Pain Society Quality of Care Task Force. Arch Intern Med 165:1574–1580. doi:10.1001/archinte.165.14.1574

    Article  PubMed  Google Scholar 

  10. 10.

    Kehlet H, Wilkinson RC, Fischer HB, Camu F (2007) PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol 21:149–159

    Article  PubMed  Google Scholar 

  11. 11.

    Rosenquist RW, Rosenberg J (2003) Postoperative pain guidelines. Reg Anesth Pain Med 28:279–288

    PubMed  Google Scholar 

  12. 12.

    Meissner W, Mescha S, Rothaug J, Zwacka S, Goettermann A, Ulrich K, Schleppers A (2008) Quality improvement in postoperative pain management: results from the QUIPS project. Dtsch Arztebl Int 105:865–870. doi:10.3238/arztebl.2008.0865

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Dal Pont G (1961) Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv 19:42–47

    PubMed  Google Scholar 

  14. 14.

    Trauner R, Obwegeser H (1957) The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. II. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol 10:787–792 contd

    Article  PubMed  Google Scholar 

  15. 15.

    Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM (2000) Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 84:6–10

    Article  PubMed  Google Scholar 

  16. 16.

    Neugebauer E, Sauerland S, Keck V, Simanski C, Witte J (2003) Surgical pain management. A Germany-wide survey including the effect of clinical guidelines. Chirurg 74:235–238. doi:10.1007/s00104-003-0615-9

    Article  PubMed  Google Scholar 

  17. 17.

    Sommer M, Geurts JW, Stessel B, Kessels AG, Peters ML, Patijn J, van Kleef M, Kremer B, Marcus MA (2009) Prevalence and predictors of postoperative pain after ear, nose, and throat surgery. Arch Otolaryngol Head Neck Surg 135:124–130. doi:10.1001/archoto.2009.3

    Article  PubMed  Google Scholar 

  18. 18.

    Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, Angelillo IF, Mosteller F (1998) The comparative effects of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analyses of randomized, controlled trials. Anesth Analg 86:598–612

    Article  PubMed  Google Scholar 

  19. 19.

    Beattie WS, Buckley DN, Forrest JB (1993) Epidural morphine reduces the risk of postoperative myocardial ischaemia in patients with cardiac risk factors. Can J Anaesth 40:532–541. doi:10.1007/BF03009738

    Article  PubMed  Google Scholar 

  20. 20.

    Hyllested M, Jones S, Pedersen JL, Kehlet H (2002) Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 88:199–214

    Article  PubMed  Google Scholar 

  21. 21.

    Meissner W, Ullrich K, Zwacka S (2006) Benchmarking as a tool of continuous quality improvement in postoperative pain management. Eur J Anaesthesiol 23:142–148. doi:10.1017/S026502150500205X

    Article  PubMed  Google Scholar 

  22. 22.

    Meissner W (2010) Focus on pain. Quality assurance in pain treatment. Anasthesiol Intensivmed Notfallmed Schmerzther 45:718–719. doi:10.1055/s-0030-1268874

    Article  PubMed  Google Scholar 

  23. 23.

    Choiniere M, Melzack R, Girard N, Rondeau J, Paquin MJ (1990) Comparisons between patients’ and nurses’ assessment of pain and medication efficacy in severe burn injuries. Pain 40:143–152

    Article  PubMed  Google Scholar 

  24. 24.

    Rundshagen I, Schnabel K, Standl T, Schulte am Esch J (1999) Patients’ vs nurses’ assessments of postoperative pain and anxiety during patient- or nurse-controlled analgesia. Br J Anaesth 82:374–378

    Article  PubMed  Google Scholar 

  25. 25.

    Klopfenstein CE, Herrmann FR, Mamie C, Van Gessel E, Forster A (2000) Pain intensity and pain relief after surgery. A comparison between patients’ reported assessments and nurses’ and physicians’ observations. Acta Anaesthesiol Scand 44:58–62

    Article  PubMed  Google Scholar 

  26. 26.

    Sloman R, Rosen G, Rom M, Shir Y (2005) Nurses’ assessment of pain in surgical patients. J Adv Nurs 52:125–132. doi:10.1111/j.1365-2648.2005.03573.x

    Article  PubMed  Google Scholar 

  27. 27.

    Lehmkuhl D, Meissner W, Neugebauer EA (2011) Evaluation of the “initiative pain-free clinic” for quality improvement in postoperative pain management. A prospective controlled study. Schmerz 25:508–515. doi:10.1007/s00482-011-1054-z

    Article  PubMed  Google Scholar 

  28. 28.

    Laubenthal H and Deutsche Interdisziplinäre Vereinigung für Schmerztherapie (2008) S3-Leitlinie Behandlung akuter perioperativer und posttraumatischer Schmerzen mit 97 Tabellen. Dt. Ärzte-Verl., Köln

  29. 29.

    Rathmell JP, Wu CL, Sinatra RS, Ballantyne JC, Ginsberg B, Gordon DB, Liu SS, Perkins FM, Reuben SS, Rosenquist RW, Viscusi ER (2006) Acute post-surgical pain management: a critical appraisal of current practice, December 2-4, 2005. Reg Anesth Pain Med 31:1–42. doi:10.1016/j.rapm.2006.05.002

    PubMed  Google Scholar 

  30. 30.

    Benhamou D, Berti M, Brodner G, De Andres J, Draisci G, Moreno-Azcoita M, Neugebauer EA, Schwenk W, Torres LM, Viel E (2008) Postoperative Analgesic THerapy Observational Survey (PATHOS): a practice pattern study in 7 central/southern European countries. Pain 136:134–141. doi:10.1016/j.pain.2007.06.028

    Article  PubMed  Google Scholar 

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Correspondence to Gregor F. Raschke.

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The authors declare that they have no conflict of interest.

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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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Keywords

  • Postoperative pain
  • Orthognathic surgery
  • Bilateral sagittal split osteotomy