Preoperatıve Diclofenac Sodium and Tramadol for Pain Relief After Bimaxillary Osteotomy
Purpose
The aim of this study was to compare the postoperative analgesic affects of preoperative use of a synthetic opioid tramadol and a nonsteroidal anti-inflammatory drug diclofenac sodium for postoperative pain, with placebo, in patients undergoing bimaxillary osteotomy.
Patients and Methods
Thirty-six orthognathic surgery patients who underwent both Le Fort I osteotomy in the maxilla and bilateral sagittal split ramus osteotomy in the mandible as bimaxillary osteotomy were randomly allocated into 3 groups via sealed envelope technique. Group T (n = 12), group D (n = 12), and group P (n = 12) received preoperative 50 mg tramadol intramuscularly, 75 mg diclofenac sodium intramuscularly, and saline, respectively. Postoperative pain intensity (visual analog scale, verbal pain score), postoperative opioid consumption with intravenous patient-controlled analgesia, hemodynamic variables, and postoperative complications were compared among the 3 groups.
Results
The median number of patient-controlled analgesia demands (n) in group P (34, 28-39) was higher than other groups (group D 14, 11-13; group T 19, 12-25; P = .001). Total tramadol consumption was higher in group P (330 mg, 290-390) compared with group D (260 mg, 190-340; P = .046) and group T (270 mg, 200-330; P = .034). The 3 groups were comparable for the area under the hemodynamic variables time curves. The area under the visual analog scale and verbal pain score curves were lower in group D and group T compared with group P, however, there was no significant difference between group T and group D.
Conclusions
Preoperative diclofenac or tramadol, compared with placebo, effectively decreases postoperative opioid consumption via intravenous patient-controlled analgesia.
⁎Chief Resident, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey.
†Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey.
‡Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey.
§Professor, Department of Anesthesiology and Reanimation, Medical Faculty, Ankara University, Ankara, Turkey.
∥Specialist, Department of Anesthesiology and Reanimation, Medical Faculty, Ankara University, Ankara, Turkey.
Address correspondence and reprint requests to Dr Tuzuner: Ankara University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Besevler, Ankara, Turkey
ABSTRACT