Factors that affect intravenous patient-controlled analgesia for postoperative pain following orthognathic surgery for mandibular prognathism

Yoshinori Aoki; Kaori Yoshida; Daisuke Nishizawa; Shinya Kasai; Tatsuya Ichinohe; Kazutaka Ikeda; Ken-ichi Fukuda

doi:10.1371/journal.pone.0098548

Factors that affect intravenous patient-controlled analgesia for postoperative pain following orthognathic surgery for mandibular prognathism

PLoS One. 2014 Jun 3;9(6):e98548. doi: 10.1371/journal.pone.0098548. eCollection 2014.

Authors

Yoshinori Aoki¹, Kaori Yoshida¹, Daisuke Nishizawa², Shinya Kasai², Tatsuya Ichinohe³, Kazutaka Ikeda², Ken-ichi Fukuda³

Affiliations

¹ Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.
² Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
³ Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.

Abstract

The predictors of postoperative pain and analgesic consumption were previously found to include preoperative pain, anxiety, age, type of surgery, and genotype, but remaining unclear was whether intraoperative factors could predict postoperative pain. In the present study, we investigated the time-course of fentanyl consumption using intravenous patient-controlled analgesia records from patients who underwent orthognathic surgery for mandibular prognathism and analyzed the influence of anesthesia methods and surgical methods together with sex on the time course. A significant difference in the time course of fentanyl administration was found (P<0.001). No significant difference in the time course of fentanyl administration was found between males and females (P = 0.653), with no interaction between time course and sex (P = 0.567). No significant difference in the time course of fentanyl administration was found among anesthesia methods, such as fentanyl induction followed by fentanyl maintenance, fentanyl induction followed by remifentanil maintenance, and remifentanil induction followed by remifentanil maintenance (P = 0.512), but an interaction between time course and anesthesia method was observed (P = 0.004). A significant difference in the time course of fentanyl administration was found between surgical methods, such as bilateral mandibular sagittal split ramus osteotomy (BSSRO) and BSSRO combined with Le Fort I osteotomy (bimaxillary; P = 0.008), with no interaction between time course and surgical method (P = 0.535). Total postoperative 24 h consumption associated with the bimaxillary procedure was significantly higher than with BSSRO (P = 0.008). The present results indicate that administration patterns and total 24 h consumption were different among the three groups of anesthesia methods and between the two groups of surgical methods, respectively. Although more research on patient-controlled analgesia patterns and consumption is necessary, the present study will contribute to adequately relieving individual patients from postoperative pain.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Analgesia, Patient-Controlled / methods*
Female
Fentanyl / therapeutic use
Humans
Male
Middle Aged
Orthognathic Surgery / methods
Pain, Postoperative / drug therapy*
Young Adult

Substances

Fentanyl

Grants and funding

This work was supported by grants from the Ministry of Health, Labour and Welfare (MHLW) of Japan (H21-3jigan-ippan-011, H22-Iyaku-015, and H25-Iyaku-020), JSPS KAKENHI grant no. 20602020, 20390162, 23390377, 24790544, 24659549, and 26293347, MEXT KAKENHI grant no. 25116532, the Smoking Research Foundation, the Naito Foundation, and the Astellas Foundation for Research on Metabolic Disorders. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.