Determining the effects of topical injection of bupivacaine with and without fentanyl at the site of surgery in open reduction mandibular surgeries on acute pain intensity and opioid requirement: a randomized clinical trial

Abstract

Introduction: Postoperative pain is one of the most common concerns of patients. Open reduction of the mandible is one of the surgeries for which insufficient studies have been conducted on the effect of drugs on postoperative pain. The aim of this study is to investigate the effects of local injection of bupivacaine with and without fentanyl at the operative site in mandibular open reduction surgeries on the severity of acute pain and the need for opioids. Methods: In this double-blind clinical trial, after ethical approval and receipt IRCT code and obtaining satisfaction from the patients according to the inclusion and exclusion criteria, the participants were randomized and matched in terms of age and gender. They were placed in two groups (intervention: with fentanyl / control: without fentanyl) and their information was collected by a checklist. In both groups, the amount of opioid used, hemodynamic indices, oxygen saturation and pain intensity were collected based on the ten-point Visual Analogue Scale (VAS) scale every 4 hours for 24 hours. SPSS version 24 software was used for data analysis. A probability value of less than 0.05 was considered as a significant level. Results: A total of 44 patients who were candidates for open reduction of isolated mandibular fractures referred to the maxillofacial surgery department of Imam Reza Hospital during the year 2022 were included in the study. There was no significant difference between the two groups in terms of basic and demographic variables such as gender, age, ASA class and duration of surgery (P>0.05). The results of statistical analysis did not show any significant difference between the two groups in terms of the incidence of nausea and vomiting and subsequently receiving anti-nausea medication (P>0.05). The need for postoperative opioid in the bupivacaine + fentanyl group (13.6%) was significantly less than those who received only bupivacaine (45.5%) (P<0.05). Changes in pain score over time were significantly different in the two groups, and bupivacaine + fentanyl reduced pain more than bupivacaine (P<0.05). However, over time, there was no significant difference between the two groups in terms of changes in oxygen saturation, heart rate, systolic blood pressure, and diastolic blood pressure (P>0.05). Conclusion: Addition of fentanyl to bupivacaine for supraperiosteal injection in the open reduction surgery site reduces postoperative pain in the first 24 hours and reduces the need for opioids without causing complications such as nausea and vomiting.