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Comparative Evaluation of IV Paracetamol Versus IV Dexmedetomidine in Inpatient Oral and Maxillofacial Surgery: A Double-Blinded Randomized Controlled Study

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Abstract

Purpose

Reconstructive surgeries following fractures in the maxillofacial region often involve considerable bone manipulation, and paracetamol is a commonly used analgesic medication in both intraoperative and postoperative periods. Dexmedetomidine, an alpha-2 adrenoceptor agonist, has both sedative and analgesic properties with minimal cardiorespiratory effects and has been used primarily for its sedative properties in oral and maxillofacial surgery.

Aims and Objectives

To compare the intraoperative analgesic requirements among patients undergoing oral and maxillofacial surgery who receive IV paracetamol versus IV dexmedetomidine. The time to requirement for the first postoperative analgesic dose and safety and adverse events of both medications were also assessed.

Patients and Methods

In total, 64 patients needing primary reconstructive surgery for facial fractures were recruited and divided into two groups for this double-blinded study. Patients were randomized to receive a preinduction dose of either IV paracetamol 1 g (Group P) or IV dexmedetomidine 1 µg/kg (Group D). Sedation scores (Ramsay sedation scale), maximal interincisal distance and pain scores at maximal mouth opening (visual analogue scale) were assessed in both groups just prior to and after the administration of the study drugs. After induction, Group P and Group D received a maintenance dose of normal saline and dexmedetomidine (0.5 µg/kg/h) during the intraoperative period, respectively. Standard noninvasive cardiorespiratory monitoring was done for the entire duration of surgery. Following extubation, postoperative pain scores and the time to request for first analgesic dose in either group were recorded.

Results

The time taken to perform the surgery was comparable in both groups. There was a significant difference between the groups in visual analogue scores and interincisal distance after the bolus dose (p < 0.05). Systolic and diastolic blood pressure was significantly lower in Group D at around 150 and 175 min of surgery. While the intraoperative fentanyl consumption was comparable in both groups, the time to request for the first analgesic dose in the postoperative period was significantly delayed in Group P (p < 0.05). No adverse cardiopulmonary events were observed in either group.

Conclusion

The intraoperative anesthetic and analgesic requirements and hemodynamic stability were comparable in IV paracetamol and dexmedetomidine groups. Dexmedetomidine did not confer any enhanced analgesia effect in the postoperative period. More research examining the role of dexmedetomidine for longer duration inpatient oral and maxillofacial surgery is needed.

Clinical Trial Number

http://ClinicalTrials.gov (No. CTRI/2017/08/009468).

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References

  1. Alexander M, Krishnan B, Yuvaraj V (2009) Prophylactic antiemetics in oral and maxillofacial surgery: a requiem? J Oral Maxillofac Surg 67:1873–1877

    Article  Google Scholar 

  2. Yeh F, Shessel B, Kaltman S (2012) The intraoperative use of multimodal analgesia in controlling postoperative pain in the orthognathic patient. J Oral Maxillofac Surg 70:E34–E35

    Article  Google Scholar 

  3. Arslan M, Celep B, Ciçek R, Kalender HÜ, Yılmaz H (2013) Comparing the efficacy of preemptive paracetamol on the reducing effect of opioid usage in cholecystectomy. J Res Med Sci 18:172–177

    PubMed  PubMed Central  Google Scholar 

  4. Kramer KJ, Brady JW (2018) Anesthetic agents commonly used by oral and maxillofacial surgeons. Oral Maxillofac Surg Clin North Am 30:155–164

    Article  Google Scholar 

  5. Singh V, Thepra M, Kirti S, Kumar P, Priya K (2018) Dexmedetomidine as an additive to local anesthesia: a step to development in dentistry. J Oral Maxillofac Surg. https://doi.org/10.1016/j.joms.2018.05.037

    Article  PubMed  Google Scholar 

  6. Davoudi A, Movahedian Attar B, Shadmehr E (2017) Risks and benefits of pre-operative dexmedetomidine in oral and maxillofacial surgeries: a systematic review. Expert Opin Drug Saf 16:711–720

    Article  Google Scholar 

  7. Atencio I, Beushausen M, Kowalczyk JJ, Flores-Hidalgo A, Fino NF, Baur DA (2018) Use of intravenous acetaminophen in postoperative pain management after partial and full bony impacted third molar extractions: a randomized double-blind controlled trial. J Oral Maxillofac Surg 76:1414–1417

    Article  Google Scholar 

  8. Guo TZ, Jiang JY, Buttermann AE, Maze M (1996) Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology 84:873–881

    Article  CAS  Google Scholar 

  9. Gurbet A, Basagan-Mogol E, Turker G, Ugun F, Kaya FN, Ozcan B (2006) Intraoperative infusion of dexmedetomidine reduces perioperative analgesic requirements. Can J Anaesth 53:646–652

    Article  Google Scholar 

  10. Keniya VM, Ladi S, Naphade R (2011) Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth 55:352–357

    Article  CAS  Google Scholar 

  11. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ (2004) The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg 98:153–158

    Article  CAS  Google Scholar 

  12. Tufanogullari B, White PF, Peixoto MP, Kianpour D, Lacour T, Griffin J et al (2008) Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables. Anesth Analg 106(6):1741–1748

    Article  CAS  Google Scholar 

  13. Cortinez LI, Hsu YW, Sum-Ping ST, Young C, Keifer JC, Macleod D et al (2004) Dexmedetomidine pharmacodynamics: part II—crossover comparison of the analgesic effect of dexmedetomidine and remifentanil in healthy volunteers. Anesthesiology 101:1077–1083

    Article  CAS  Google Scholar 

  14. Swaika S, Parta N, Chattopadhyay S, Bisui B, Banarjee SS, Chattarjee S (2013) A comparative study of the efficacy of intravenous paracetamol and dexmedetomidine on peri-operative hemodynamics and post-operative analgesia for patients undergoing laparoscopic cholecystectomy. Anesth Essays Res 7:331–335

    Article  Google Scholar 

  15. Sinatra RS, Jahr JS, Reynolds LW, Viscusi ER, Groudine SB, Payen-Champenois C (2005) Efficacy and safety of single and repeated administration of 1 gram intravenous acetaminophen injection (paracetamol) for pain management after major orthopedic surgery. Anesthesiology 102:822–831

    Article  CAS  Google Scholar 

  16. Venn RM, Karol MD, Grounds RM (2002) Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive care. Br J Anaesth 88:669–675

    Article  CAS  Google Scholar 

  17. Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD (2000) The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 93:382–394

    Article  CAS  Google Scholar 

  18. Rummasak D, Apipan B (2014) Evaluation of the advantageous anesthetic properties of dexmedetomidine used as hypotensive agent compared with nitroglycerin in orthognathic surgery. J Oral Maxillofac Surg 72:2428–2433

    Article  Google Scholar 

  19. Han LJ, Seok SJ, Young YJ, Hong KC, Kyo CI, Deok KY et al (2013) The effect of dexmedetomidine on post-operative care and hemodynamic patterns after bimaxillary orthognathic surgery. Int J Oral Maxfac Surg 42:1331

    Google Scholar 

  20. Simpson P (1992) Perioperative blood loss and its reduction: the role of the anaesthetist. Br J Anaesth 69:498–507

    Article  CAS  Google Scholar 

  21. Durmus M, But AK, Dogan Z, Yucel A, Miman MC, Ersoy MO (2007) Effect of dexmedetomidine on bleeding during tympanoplasty or septorhinoplasty. Eur J Anaesthesiol 24:447–453

    Article  CAS  Google Scholar 

  22. Richa F, Yazigi A (2007) Letter to editor. Effect of dexmedetomidine on blood pressure and bleeding in maxillofacial surgery. Eur J Anesth 24:985–986

    Article  CAS  Google Scholar 

  23. Oliveira CR, Bernardo WM, Nunes VM (2017) Benefit of general anesthesia monitored by bispectral index compared with monitoring guided only by clinical parameters. Systematic review and meta-analysis. Braz J Anesthesiol 67:72–84

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Jawaharalal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605005, India

    K. Guru, S. Adinarayanan, Satyen Parida, B. Hemavathi, Prasanna Udupi Bidkar & K. Narmadhalakshmi

  2. Department of Dentistry, Jawaharalal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, 605005, India

    B. Krishnan

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  1. K. Guru
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  2. S. Adinarayanan
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  3. B. Krishnan
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  4. Satyen Parida
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  5. B. Hemavathi
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  6. Prasanna Udupi Bidkar
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  7. K. Narmadhalakshmi
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Correspondence to S. Adinarayanan.

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Guru, K., Adinarayanan, S., Krishnan, B. et al. Comparative Evaluation of IV Paracetamol Versus IV Dexmedetomidine in Inpatient Oral and Maxillofacial Surgery: A Double-Blinded Randomized Controlled Study. J. Maxillofac. Oral Surg. 19, 394–400 (2020). https://doi.org/10.1007/s12663-019-01264-3

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  • DOI: https://doi.org/10.1007/s12663-019-01264-3

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