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Erschienen in: Clinical Oral Investigations 1/2018

14.03.2017 | Original Article

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

verfasst von: Gregor F. Raschke, Winfried Meissner, Andre Peisker, Gabriel Djedovic, Ulrich Rieger, Arndt Guentsch, Marta Gomez Dammeier, Stefan Schultze-Mosgau

Erschienen in: Clinical Oral Investigations | Ausgabe 1/2018

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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.
Literatur
3.
Zurück zum Zitat 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 76:657–667PubMed 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 76:657–667PubMed
4.
Zurück zum Zitat 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 41:173–179CrossRefPubMed 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 41:173–179CrossRefPubMed
5.
Zurück zum Zitat Gureje O, Simon GE, Von Korff M (2001) A cross-national study of the course of persistent pain in primary care. Pain 92:195–200CrossRefPubMed Gureje O, Simon GE, Von Korff M (2001) A cross-national study of the course of persistent pain in primary care. Pain 92:195–200CrossRefPubMed
6.
Zurück zum Zitat Warfield CA, Kahn CH (1995) Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology 83:1090–1094CrossRefPubMed Warfield CA, Kahn CH (1995) Acute pain management. Programs in U.S. hospitals and experiences and attitudes among U.S. adults. Anesthesiology 83:1090–1094CrossRefPubMed
8.
Zurück zum Zitat 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 contentsCrossRefPubMed 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 contentsCrossRefPubMed
9.
Zurück zum Zitat 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 CrossRefPubMed 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 CrossRefPubMed
10.
Zurück zum Zitat Kehlet H, Wilkinson RC, Fischer HB, Camu F (2007) PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol 21:149–159CrossRefPubMed Kehlet H, Wilkinson RC, Fischer HB, Camu F (2007) PROSPECT: evidence-based, procedure-specific postoperative pain management. Best Pract Res Clin Anaesthesiol 21:149–159CrossRefPubMed
11.
Zurück zum Zitat Rosenquist RW, Rosenberg J (2003) Postoperative pain guidelines. Reg Anesth Pain Med 28:279–288PubMed Rosenquist RW, Rosenberg J (2003) Postoperative pain guidelines. Reg Anesth Pain Med 28:279–288PubMed
13.
Zurück zum Zitat Dal Pont G (1961) Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv 19:42–47PubMed Dal Pont G (1961) Retromolar osteotomy for the correction of prognathism. J Oral Surg Anesth Hosp Dent Serv 19:42–47PubMed
14.
Zurück zum Zitat 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 contdCrossRefPubMed 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 contdCrossRefPubMed
15.
Zurück zum Zitat 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 84:6–10CrossRefPubMed 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 84:6–10CrossRefPubMed
17.
Zurück zum Zitat 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 CrossRefPubMed 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 CrossRefPubMed
18.
Zurück zum Zitat 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 86:598–612CrossRefPubMed 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 86:598–612CrossRefPubMed
19.
Zurück zum Zitat 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 CrossRefPubMed 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 CrossRefPubMed
20.
Zurück zum Zitat 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 88:199–214CrossRefPubMed 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 88:199–214CrossRefPubMed
23.
Zurück zum Zitat 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 40:143–152CrossRefPubMed 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 40:143–152CrossRefPubMed
24.
Zurück zum Zitat 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 82:374–378CrossRefPubMed 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 82:374–378CrossRefPubMed
25.
Zurück zum Zitat 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 44:58–62CrossRefPubMed 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 44:58–62CrossRefPubMed
27.
Zurück zum Zitat 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 CrossRefPubMed 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 CrossRefPubMed
28.
Zurück zum Zitat Laubenthal H and Deutsche Interdisziplinäre Vereinigung für Schmerztherapie (2008) S3-Leitlinie Behandlung akuter perioperativer und posttraumatischer Schmerzen mit 97 Tabellen. Dt. Ärzte-Verl., Köln 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.
Zurück zum Zitat 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 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
30.
Zurück zum Zitat 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 CrossRefPubMed 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 CrossRefPubMed
Metadaten
Titel
Bilateral sagittal split osteotomy-parameters and correlations of postoperative pain management
verfasst von
Gregor F. Raschke
Winfried Meissner
Andre Peisker
Gabriel Djedovic
Ulrich Rieger
Arndt Guentsch
Marta Gomez Dammeier
Stefan Schultze-Mosgau
Publikationsdatum
14.03.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Clinical Oral Investigations / Ausgabe 1/2018
Print ISSN: 1432-6981
Elektronische ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-017-2097-z

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