Comparison of intranasal administration with intravenous injection of dexmedetomidine in postoperative pain control of mandibular fractures

Abstract

Since pain management is very important in mandibular fractures and the use of opioids can be associated with complications such as respiratory depression and the need for re-intubation of patients, non-opioid pain control methods are very important for these patients. On the other hand, there is a difference of opinion in the efficiency, safety and effectiveness of different methods of dexmedetomidine administration; Therefore, in this study, we decided to compare the effectiveness, safety and efficiency of two methods of intranasal administration and intravenous administration of dexmedetomidine in reducing the intensity of acute pain after mandibular surgeries. Methods: This study was a randomized and double-blind clinical trial; All patients underwent general anesthesia, laryngoscopy and endotracheal intubation in the same way. For the patients in the intranasal administration group, this drug will be administered at the rate of 0.2 mcg/kg half an hour before the start of anesthesia (in the form of drops) and for the patients in the intravenous injection group, 0.5 mcg/kg of the drug will be administered as a bolus. And it was administered within ten minutes and half an hour before anesthesia. During the first 24 hours after surgery, the hemodynamic status of all patients, pain intensity, and the total amount of opioid medication in milligrampetidine were also recorded for each patient. The severity of nausea and vomiting and the degree of agitation were also recorded in the recovery unit at the mentioned times. The incidence of complications such as bradycardia (heart rate drop below 55 beats per minute) and blood pressure drop in patients treated with vasopressors were recorded. Results: The comparison of pain intensity between two groups at different times after surgery indicated that in the recovery unit and one hour after discharge from recovery (T1) there was no statistically significant difference in pain intensity between the two groups, while in the second hour (T2), fourth (T3), sixth (T4), twelfth (T5) pain intensity was significantly lower in the intranasal dexmedetomidine group; In the first hour after surgery, the average amount of pethidine injected between the two groups was without statistically significant difference, while in the rest of the hours (second, fourth, sixth, twelfth, eighteenth and twenty-fourth) after surgery, the pethidine injected in the intranasal dexmedetomidine group was It was significantly lower than intravenous dexmedetomidine; Also, the average total pethidine injected in the intranasal dexmedetomidine group was significantly lower than that of intravenous dexmedetomidine.