Comparison of opioid requirement and pain intensity after mandibular surgeries in intraoperative infusion and bolus injection during dexmedetomidine extubation: a randomized clinical trial

Abstract

Introduction: Postoperative pain following maxillofacial surgeries is moderate to severe during the first 24 hours and requires proper management and the use of pharmaceutical methods with minimal side effects. The purpose of this study is to compare the amount of opioid required and pain intensity after mandibular fracture surgeries with dexmedetomidine by infusion during surgery and bolus injection during extubation. 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 in two group (infusion and bolus) and their information was collected by checklist. In both groups, the amount of narcotic used, hemodynamic indices, oxygen saturation and pain intensity were collected based on the ten-point Visual Analogue Scale (VAS) at 7 time points 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 40 patients who were candidates for reduction of isolated mandibular fractures referred to the maxillofacial surgery department of Imam Hospital during 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 opioid consumption after surgery was not different in two groups (P>0.05). Changes in the pain score over time were significantly different in the two groups, and administration of dexmedetomidine infusion reduced pain more than its bolus dose (P<0.05). However, over time, there was no significant difference between the two groups in terms of changes in oxygen saturation variables (P>0.05). Homodynamic indices including heart rate, systolic blood pressure and diastolic blood pressure in the bolus group were significantly lower than the infusion group (P<0.05). Conclusion: Administration of dexmedetomidine in the form of infusion can reduce pain after surgery better than bolus injection, and in addition, the possibility of hypotension and bradycardia, which are known side effects of dexmedetomidine, is also reduced in the administration of infusion.