Comparison of intranasal versus intravenous dexmedetomidine in postoperative pain control in traumatic mandibular fractures surgery: a randomized clinical trial
Abstract
Objective: Effective pain management in mandibular fractures is crucial due to the complications associated with opioids, such as respiratory depression and re-intubation. Non-opioid methods are therefore important. This study aims to compare the effectiveness, safety, and efficiency of intranasal (IN) versus intravenous (IV) dexmedetomidine (Dex) for reducing acute pain following mandibular surgery. Methods: This study was a randomized, double-blind clinical trial. All patients underwent general anesthesia, laryngoscopy, and intubation in a standardized manner. For the IN administration group, Dex was prescribed at a dose of 0.2 µ/kg (in the form of drops) half an hour before the start of anesthesia. For the IV administration group, Dex was administered at a dose of 0.5 µ/kg intravenously over ten minutes, half an hour before anesthesia. During the first 24 hours after surgery, pain intensity and the total amount of opioid medication (measured in mg of pethidine) were recorded for each patient. Results: There was no significant difference in pain intensity between the two groups in the post-anesthesia care unit (P=0.898), one hour (P=0.052) and 24 hours post-surgery (P=0.898). However, pain intensity was significantly lower in the IN Dex group at the second (P=0.044), fourth (P=0.041), sixth (P=0.048), and twelfth (P=0.025) hours. Total pethidine injected in the IN Dex group was significantly lower than in the IV Dex group (P=0.041). Conclusion: This study underscores the efficacy of IN Dex as a viable alternative for postoperative pain management in traumatic mandibular fracture surgeries.
2. Etemadi Sh M, Kaviani N, Salimian K, Tajmiri G. Effect of dexmedetomidine added to lidocaine cartridge on the level of patient sedation, cooperation, and patient and surgeon satisfaction during mandibular third-molar extraction surgery: a randomized double-blind controlled trial. Int J Dent. (2022);2:1-8.
3. Mishra N, Birmiwal KG, Pani N, Raut S, Sharma G, Rath KC. Sedation in oral and maxillofacial day care surgery: a comparative study between intravenous dexmedetomidine and midazolam. Natl J Maxillofac Surg. 2016;7(2):178-85.
4. Gertler R, Brown HC, Mitchell DH, Silvius EN Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001;14(1):13-21.
5. Singaram M, Udhayakumar RK. Prevalence, pattern, etiology, and management of maxillofacial trauma in a developing country: a retrospective study. J Korean Assoc Oral Maxillofac Surg. 2016;42(4):174-81.
6. Mesgarzadeh AH, Aghamohamadi D, Asl DM, Yazdani J, Amani M, Purlak T. Effect of long-acting local anesthetic infiltration in surgical wound for post-operative pain control in zygomaticomaxillary complex fracture. Int J Curr Res Acad Rev. 2015;3:405-14.
7. Procedural sedation in the emergency department. Policy statement by the American college of emergency physicians. 2023:1-2.
8. Bakshi SG, Paulin SV, Bhawalkar P.A randomised controlled trial to evaluate the peri-operative role of intraoperative dexmedetomidine infusion in robotic-assisted laparoscopic oncosurgeries. Indian J Anaesth. 2020;64(9):784-9.
9. Khan TU, Rahat S, Khan ZA, Shahid L, Banouri SS et al.Etiology and pattern of maxillofacial trauma. J PLoS ONE. 2022;17(9):1-10.
10. Gursoytrak B, Kocaturk O, Koparal M, Gulsun B. Assessment of effect of submucosal injection of dexmedetomidine on postoperative symptoms. J Oral Maxillofac Surg. 2019;78(3):366-71.
11. Stamenkovic DM, Bezmarevic M, Bojic S, Unic-Stojanovic D, Stojkovic D, Slavkovic DZ, Bancevic V, Maric N, Karanikolas M. Updates on wound infiltration use for postoperative pain management: a narrative review. J Clin Med. 2021;10(20):4659.
12. Fasil F, Saundattikar G, Jawale RH. Study of hemodynamic effects of preoperative single-bolus dexmedetomidine in elective laparoscopic surgeries. J Pharmacol Pharmacother. 2022;13(1):85-91.
13. Ju Yeon Cho Cho JS, Kim HI, Lee KY, et al. Effect of intraoperative dexmedetomidine infusion on postoperative bowel movements in patients undergoing laparoscopic gastrectomy: a prospective, randomized, placebo-controlled study. Medicine (Baltimore). 2015;94(24):e959.
.
14. Raghu R, Indira P, Swetha A. Effects of preoperative single bolus dose of dexmedetomidine on perioperative hemodynamics in elective laparoscopic cholecystectomy. Indian J Clin Anaesth. 2019;6(1):47-54.
15. Gadve VR, Shenoi R, Vats V, Shrivastava A. Evaluation of anxiety, pain, and hemodynamic changes during surgical removal of lower third molar under local anesthesia. Ann Maxillofac Surg. 2018;8(2):247-53.
16. Garip L, Verbist J, Stragier H, Meyns J, Mesotten D, Vundelinckx J. A comparative study of patient satisfaction about anesthesia with dexmedetomidine for ambulatory dental surgery. BMC Res Notes. 2022;15(1):376-83.
17. Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: a systematic review and meta-analysis. Br J Anaesth. 2013;110:915-25.
18. Le Guen M, Liu N, Tounou F, Augé M, Tuil O, Chazot T, et al. Dexmedetomidine reduces propofol and remifentanil requirements during bispectral index-guided closed-loop anesthesia: a double-blind, placebo-controlled trial. Anesth Analg. 2014;118:946-55.
19. Elsawy A. Dexmedetomidine is an excellent additive to local anaesthesia for postoperative analgesia in bilateral third molar teeth extraction surgery. Al-Azhar Int Med J. 2021;2.
20. Cheung CW, Ng KF, Choi WS, Chiu WK, Ying CL, Irwin MG. Evaluation of the analgesic efficacy of local dexmedetomidine application. Clin J Pain. 2011;27:377-82.
21. Eftekharian H, Zamiri B, Ahzan S, Talebi M, Zarei K. Orthognathic surgery patients (maxillary impaction and setback plus mandibular advancement plus genioplasty) need more intensive care unit (ICU) admission after surgery. J Dent (Shiraz).2015;16:43-9.
22. Wang L, Zhou Y, Zhang T, Huang L, Peng W. Comparison in sedative effects between dexmedetomidine and midazolam in dental implantation: a randomised clinical trial. Biomed Res Int. 2020;6130162.
23. Shams T, El Bahnasawe NS, Abu-Samra M, El-Masry R. Induced hypotension for functional endoscopic sinus surgery: a comparative study of dexmedetomidine versus esmolol. Saudi J Anaesth. 2013;7:175-80.
24. Jha AK, Bhardwaj N, Yaddanapudi S, Sharma RK, Mahajan JK. A randomized study of surgical site infiltration with bupivacaine or ketamine for pain relief in children following cleft palate repair. Paediatr Anaesth. 2013; 23:401-6.
| Files | ||
| Issue | Vol 8 No 4 (2024): Autumn (October) | |
| Section | Original article | |
| DOI | 10.18502/fem.v8i4.17083 | |
| Keywords | ||
| Dexmedetomidine Intranasal Intravenous Postoperative Pain Traumatic Mandibular Fractures | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
