纳布啡联合舒芬太尼对颌面部骨折患者 术后镇痛及炎症因子水平的影响

目的:观察纳布啡联合舒芬太尼对颌面部骨折患者术后镇痛效果以及炎症因子水平的变化.方法:将2019年8月～2019年11月期间在我院接受术后静脉自控镇痛的80例颌面部骨折患者作为实验对象,随机分为对照组及研究组(每组40例),其中对照组给与舒芬太尼,研究组给与纳布啡联合舒芬太尼,并对两组患者术后不同时间点(2、4、8、1...     

Patient outcomes following subepithelial connective tissue graft and free gingival graft procedures

BACKGROUND: Subepithelial connective tissue grafts (CTGs) and free gingival grafts (FGGs) are common periodontal procedures with similar indications; however, they may differ regarding patient outcomes. Reports on postoperative periodontal patient outcomes are limited. The aim of this observational trial was to compare patient-based outcomes for CTGs and FGGs. METHODS: Patients who received CTG or FGG completed postoperative questionnaires at 3 days and 3 weeks to assess pain, number of analgesic pills taken, and number of days pills were taken. Postoperative pain was assessed using a visual analog scale (VAS). RESULTS: Twenty-three subjects (12 CTGs and 11 FGGs) completed the study. Differences between CTG and FGG groups in VAS pain scores at 3 days did not reach statistical significance. The proportion of subjects reporting pain in the palate at 3 days was significantly greater for FGG (P <0.05). There were no significant intergroup differences at 3 weeks. For the FGG group, 3-week VAS pain scores were less than the 3-day ones (P <0.01). For the entire study population, the number of days analgesic pills were taken, total number of analgesic pills taken, and number of pills taken from day 3 to the end of the study correlated with the 3-week pain scores. CONCLUSIONS: FGG is associated with a greater incidence of donor site pain compared to CTG at the early postoperative period. Longer-term pain after soft tissue grafting is associated with greater analgesic usage. There is an opportunity to improve the postoperative protocols of soft tissue grafting, particularly for FGG.     

Postoperative nausea and vomiting (PONV) after orthognathic surgery: a retrospective study and literature review.

PURPOSE: Postoperative nausea and vomiting (PONV) is the most common postoperative complication after surgery and general anesthesia. PONV occurs primarily within the first 24 hours and can lead to significant morbidity, delayed hospital discharge, increased hospital costs and perhaps most importantly, poor patient satisfaction. We sought, in this study, to determine the prevalence of PONV and to identify risk factors in patients who underwent orthognathic surgery. PATIENTS AND METHODS: We conducted a retrospective cross-sectional analytic survey of 553 consecutive patients over 14 years of age, who underwent maxillary and/or mandibular osteotomies at Kaiser Permanente Hospital (Oakland, CA), between January 2003 and March 2004. Patient-, anesthesia- and surgery-related factors that were considered to have a possible effect on the prevalence of PONV events were evaluated. RESULTS: A total of 514 patients met the inclusion criteria. Among these patients, 40.08% experienced PONV during the first 24 hours after surgery. The most important predictive factors associated with an increased risk of PONV were female gender, young patients (15 to 25 years old), nonsmoking status, presence of predisposing factors (ie, prior history of motion sickness and/or PONV, vertigo or migraine headaches), use of volatile general anesthetics, maxillary surgery, postoperative pain level (PACU) and the use of postoperative analgesic opioid drugs. We found a directly proportional relationship between the number of risk factors and the prevalence of PONV. CONCLUSION: We found PONV had a high prevalence among patients undergoing orthognathic surgery. Further studies are needed to develop effective protocols for preventing this common and unpleasant problem.     

Independent predictors of satisfaction in impacted third molar surgery patients

Kim YK, Kim SM, Myoung H. Independent predictors of satisfaction in impacted third molar surgery patients. Community Dent Oral Epidemiol 2010; 38: 274–286. © 2010 John Wiley & Sons A/S Abstract – Objectives: Patient satisfaction and dissatisfaction are critical dimensions leading to favorable or unfavorable treatment outcomes. Although impacted third molar (ITM) surgery is one of the most common dental surgical procedures, it is a challenging operation because of numerous potential complications and patients generally suffer from severe psychosomatic symptoms as a result of severe perioperative anxiety. We hypothesize that multiple independent factors, including perioperative anxiety and various postoperative complications, affect satisfaction of the ITM surgery patients. Methods: Survey data from 219 participants encompassed basic patient demographic traits, difficulty of surgery, perioperative anxiety, pain sensation and common postoperative complications. The t‐test and one‐way anova with Duncan’s multiple‐range tests were applied to detect differences in mean values of perioperative anxiety, perioperative pain sensation and satisfaction based on basic demographic characteristics and postoperative complications. The significance of postoperative complications according to demographic data and difficulty of extraction was also analyzed. A paired t‐test was applied to detect the significance of anxiety level and pain sensation changes over time. Lastly, univariate and multiple stepwise regression analyses were used to analyze the relationships among perioperative anxiety, pain sensation and satisfaction to determine the predictive factor of patient satisfaction. Results: Basic demographic traits proved not to have a direct significant effect on satisfaction in ITM surgery patients, but some demographic factors and difficulty of surgery showed significant relationships with postoperative complications. Univariate analysis revealed that perioperative anxiety, pain sensation, postoperative infection, numbness/paresthesia and ecchymoses have a significant influence on patient satisfaction. In particular, preoperative anxiety level and numbness/paresthesia were independent predictive factors of patient satisfaction upon multivariate analysis. Conclusions: This study demonstrates that the patients who undergo ITM surgery often have severe anxiety that seriously impacts patient satisfaction and resultant treatment outcomes. In addition, patient satisfaction directly depends on the occurrence of some postoperative complications. Appreciation of these predictive factors and increasing patient satisfaction may help clinicians to provide optimal care for ITM surgery patients.     

Preoperative ketorolac has a preemptive effect for postoperative third molar surgical pain

There is uncertainty regarding the role of preemptive analgesia in preventing postoperative pain. Most previous studies were of parallel design completed under general anesthesia with many confounding inter-patient's variables. The present study evaluated the efficacy of preemptive ketorolac in a crossover design in patients undergoing bilateral mandibular third molar surgery. This was a double blind, randomized, placebo-controlled study where 34 patients had each of their identical impacted mandibular third molars removed under local anesthesia on two occasions. Each patients acted as their own control; one side was pretreated with intravenous ketorolac 30 mg before surgery followed by placebo injection after surgery, and for the other side, the patient was given placebo injection before surgery and post-treated with intravenous ketorolac 30 mg after surgery. The difference in postoperative pain between pretreated and post-treated side in each patient was assessed by four primary end-points: pain intensity as measured by a 100-mm visual analogue scale hourly for 12 h, time to rescue analgesic, postoperative analgesic consumption, and patient's global assessment. Throughout the 12-h investigation period, patients reported significantly lower pain intensity scores in the ketorolac pretreated sides when compared with the post-treated sides (P = 0.003). Patients also reported a significantly longer time to rescue analgesic (8.9 h versus 6.9 h, P = 0.005), lesser postoperative analgesic consumption (P = 0.007) and better global assessment for the ketorolac pretreated sides (P = 0.01). Pretreatment with intravenous ketorolac has a preemptive effect for postoperative third molar surgery and extended the analgesia by approximately 2 h.     

Assessment of preemptive analgesia with ibuprofen coadministered or not with dexamethasone in third molar surgery: a randomized double-blind controlled clinical trial

Introduction

There is no conclusive evidence from clinical trial studies regarding preemptive analgesic interventions. Clinical trials are necessary to evaluate the efficacy of preemptive analgesic interventions already demonstrated in animal studies. Thus, it is necessary to evaluate the analgesic effect of preoperative administration of ibuprofen alone or coadministered with dexamethasone after third molar surgery.

Material and methods

A randomized, double-blind, and controlled clinical trial was conducted with 94 bilateral symmetrical third molar surgeries. Preemptive analgesic medication was randomly defined: ibuprofen or placebo and ibuprofen + dexamethasone or placebo was administered to patients who served as their own control (split mouth). The variables analyzed were postoperative pain through visual analog scale (VAS), total number of rescue analgesic (TNRA), and patient satisfaction. Data were analyzed with the Mann–Whitney test.

Results

There was no significant difference (p?>?0.05) between ibuprofen and placebo for postoperative pain (VAS) and TNRA. Patients consumed less analgesics (TNRA) for dexamethasone + ibuprofen (p?<?0.05) and felt more comfortable in the postoperative period after surgery (p?<?0.05).

Discussion

The preemptive analgesia with ibuprofen was insufficient to inhibit central sensitization, whereas its association with dexamethasone was more effective in preventing pain in third molar surgery.     

心理干预对老年患者佩戴可摘局部义齿修复满意度的影响

目的：探讨修复前心理干预对初次佩戴复杂活动义齿的老年患者修复满意度的影响。方法：选择门诊80例初次进行复杂活动义齿修复的老年患者，实验组40例，修复前进行心理干预，对照组40例，常规修复，术后分别调查患者修复后第一个月和第三个月的义齿修复满意度。结果：实验组和对照组相比，第一个月和第三个月的舒适性、咀嚼、语音差异均有统计学意义（P〈0．05）。结论：初次进行复杂活动义齿修复的老年患者修复前心理干预可提高其义齿修复的满意度。     

A model for evaluating the analgesic effect of a new fixed ratio combination analgesic in patients undergoing oral surgery.

A special model designed for evaluating the analgesic effect of oral analgesics was based on a short-time registration period of immediate postoperative pain. One-hour intervals in pain registration and a minimum of 2 h between the tablet intake allowed a good estimation of changes in pain levels. The patient material consisted of 112 patients and from each patient a lower impacted wisdom tooth was removed. The test model was used to compare two analgesic drugs with placebo. The two pharmacologically active preparations were Doleron (dextropropoxyphene, acetylsalicylic acid, phenazone, caffeine and Transergan) and Astra 2167 (dextropropoxyphene and acetylsalicylic acid). The trial was double blind and the tablets were administered according to a crossover design. There was no statistically significant difference in analgesic effect between Astra 2167 and Doleron, and both drugs were superior to placebo. Finally, the trial showed that a reduction of the number of components of a compound analgesic to some degree reduced the pain relieving effect on this particular postoperative pain. This observed reduction was however, not statistically significant.     

Analgesic efficacy of flurbiprofen as compared to acetaminophen and placebo after periodontal surgery

The purpose of the present investigation was to compare the analgesic efficacy of flurbiprofen, a nonsteroidal anti-inflammatory drug, which is a phenyl propionic acid derivative, with acetaminophen and placebo in 63 adult outpatients with moderate to severe dental pain following periodontal surgery. After surgery was completed under local anesthesia, the patients received under double-blind conditions an envelope containing four tablets of either flurbiprofen 100 mg, acetaminophen 500 mg, or placebo and they were instructed to take one tablet every 6 hours when postoperative pain reached moderate to severe intensity. To determine analgesic efficacy and patients recorded pain intensity on a scale of 0 to 3. Patients were allowed to remedicate after 1 hour if pain was not reduced. Flurbiprofen was shown to possess an adequate analgesic effect superior to either placebo (P less than 0.005) or acetaminophen (P less than 0.01) in the parameters studied. Our results seem to further support earlier data obtained with the drug in dental patients with postoperative pain after the surgical removal of impacted third molars; therefore, it is concluded that flurbiprofen used as directed is a new alternative for the proper treatment of pain following periodontal surgery.     

Intra-muscular ketorolac administered as a supplemental analgesic for removal of impacted third molar teeth: a prospective study

BACKGROUND: Post-operative pain follows dentalveolar oral surgery. Ketorolac is a potent non-steroidal analgesic with moderate anti-inflammatory effects. The purpose of this study was to test whether a single supplementary dose of ketorolac reduced post-operative pain experienced by patients having third molar teeth removed. METHODS: A prospective double-blind trial utilizing 30mg of ketorolac and a standard anaesthetic and surgical technique was performed on 65 female patients having impacted third molar teeth removed. Assessment was made by means of a patient questionnaire and visual analogue pain scales and subjected to statistical analysis. RESULTS: There was a statistically significant difference confirming improved pain relief for patients receiving ketorolac 30mg at the early postoperative stage (two hours) but at later time intervals (four and six hours) there was no significant difference. Seventy two per cent of patients found ketorolac to be a satisfactory analgesic for postoperative pain. There were minimal side effects. CONCLUSION: A single supplemental dose of ketorolac 30mg provides improved pain relief in the immediate post-operative phase following the removal of third molar teeth. Oral ketorolac can be recommended as a oral analgesic for post-operative pain, with minimal side effects.     

舒芬太尼用于颌面外科术后自控镇痛的临床观察

目的:观察舒芬太尼在颌面外科手术后患者自控镇痛(PCIA)中的效应。方法:颌面外科全麻手术后接受PCA 治疗共250例,其用药选择随机分为舒芬太尼(sufentanil 简称 S)组和芬太尼(fentanyl 简称 F)F1、F2、F3、F4四个组,共5组,每组各50例。S 组用舒芬太尼总量50μg,F1～4组用芬太尼总量分别为0.5、0.6、0.7 mg 和0.8 mg。所用镇痛药均用生理盐水稀释至100 ml,持续注速2 ml/h,单次剂量0.5 ml,锁定时间15 min。分别进行视觉模拟评分(VAS)、患者满意度和不良反应的比较。结果:S 组 VAS 是1.3±0.6,F1～4组依次是1.6±0.9、1.4±0.8、1.4±0.7和1.3±0.6,S 组与 F1组有显著性差异(P<0.05)。镇痛满意率 S 组94%,F1～4组是86%、92%、90%和94%。组间不良反应发生率无显著性差异。结论:舒芬太尼可为颌面外科术后病人提供满意的镇痛效果,其效应似优于等效剂量的芬太尼。     

Influence of state anxiety and trate anxiety in postoperative in oral surgery

Introduction: The aim of this article was to study the influence of anxiety (both state and trait) in postoperative recovery after extraction of third molar together, to establish the role of each of the aspects of anxiety in the results you obtained in an independent and complementary way. Material and Methods: We performed a prospective study of a consecutive series of 88 patients who underwent lower third molar extractions. Before being provided with any information about the operation, patients were asked to complete the Spielberger State-Trait Anxiety Inventory-Trait and State. We have evaluated postoperative swelling and pain, patients completed a 10-point visual analog scale (VAS) at home each day (at approximately the same time of day as the operation) until day 8 after surgery, when the sutures were removed. Results: Regarding postoperative variables between positive and negative trait anxiety groups, consumption of analgesic drugs was higher in positive trait anxiety group in a statistically significant way, while these differences were detected only on specific occasions regarding pain and swelling. Discussion: In the present study, anxiety was taken into account and showed a significant effect in explaining postoperative pain and taking analgesics. Key words:Anxiety, satisfaction, third molar surgery, Spielberger state-trait anxiety inventory.     

Successful pain management by Finnish oral surgeons. A clinical follow-up study.

The current practice of postoperative pain management among Finnish oral surgeons was evaluated in a two-phase study. In the first phase, a questionnaire was sent to specialist members of the Finnish Society of Oral and Maxillofacial Surgeons that concerned the routine use of analgesic drugs after surgical removal of third molar teeth. In the second phase, the clinical adequacy of pain medication was assessed in 84 patients who had the same procedure. Patients estimated the intensity of pain with a 100 mm visual analogue scale at five time points during the day of surgery and on three postoperative days. Anti-inflammatory analgesics were widely used either alone or in combination with centrally acting analgesic drugs. Tolfenamic acid, diclofenac, and ketoprofen were the most commonly used analgesic drugs. The analgesic effect of the currently used drug combinations proved to be sufficient except in a few patients during the first night after surgery.     

阻生智牙拔除术后不同医嘱告知模式对

目的 比较阻生智牙拔除术后不同医嘱告知形式对疼痛、出血、肿胀等术后常见并发症发生率的影响,为降低智牙拔除术后并发症及提高患者满意度提供帮助。方法 随机选取2018年1月—2018年10月间在中南大学湘雅医院口腔颌面外科就诊的150例拔除下颌阻生智牙的患者,随机分为3组,每组50例。第1组术后接受术后医嘱口头告知,第2组术后医嘱书面告知,第3组术后医嘱口头和书面同时告知。术前获取患者的年龄、性别和受教育程度等个人信息。术后7 d记录并分析患者疼痛、出血、肿胀等并发症和对医疗行为满意度。采用SPSS 22.0软件包对数据进行统计学分析。结果 150例受试者中,男69例,女81例,平均年龄（24.6±2.6）岁。结果表明,术后医嘱口头告知组患者的术后疼痛程度显著高于书面医嘱组（P=0.001）和口头加书面医嘱组（P=0.000）,患者满意度最低;同时接受口头和书面医嘱告知的患者,术后满意度最高。结论 术后医嘱告知方式可以显著影响下颌阻生智牙拔除术后的疼痛强度和患者满意度。     

Dexmedetomidine versus midazolam in outpatient third molar surgery.

PURPOSE: The aim of this study was to compare the use of dexmedetomidine with the use of midazolam during intravenous conscious sedation in third molar surgery. PATIENTS AND METHODS: Twenty healthy patients with symmetrically impacted mandibular third molars were included in this double-blind, crossover, randomized study. Either dexmedetomidine (group D) (4 microg.kg(-1).h(-1)) or midazolam (group M) (0.4 mg.kg(-1).h(-1)) was administered intravenously for 15 minutes before the first operation. At the second operation, the other agent was applied. Cardiorespiratory data were collected. The intraoperative sedation level, patient cooperation, and postoperative performance were scored and any pain reaction during the local anesthetic injection was recorded. Visual analog scales were additionally used for the subjective assessment of pain and patient satisfaction. Amnesia was evaluated by the patients' ability to recall the objects shown during the operations and the local anesthetic injection. Patients' preferences were recorded during the interview at the end of the second operations. RESULTS: The mean heart rate and blood pressure measurements were significantly lower in group D. There was no significant difference in the respiratory findings. A significantly higher number of patients showed pain reactions in group M. Sedation level, postoperative performance, and VAS pain scores were not statistically significant, whereas the differences in cooperation score and VAS for patient satisfaction were significant. Adequate amnesia was obtained in group M, however, no amnesia was demonstrated in group D. Sixty-five percent of the patients indicated a preference for dexmedetomidine sedation. CONCLUSION: Dexmedetomidine may be a remarkable alternative to midazolam for intravenous sedation because it seems to be a reliable and safe method, with additional analgesic effect providing a satisfactory sedation level without any serious side effects during impacted third molar surgery.     

Functional outcomes and patient satisfaction after vascularized osteocutaneous scapula flap reconstruction of the mandible in patients with benign or cancerous tumours

Pre- and postoperative longitudinal assessment of oral functions including masticatory force, masticatory ability with solids, speech intelligibility, and subjective satisfaction was conducted for patients who underwent vascularized osteocutaneous scapula flap reconstruction after mandibulectomy. Postoperative changes in oral function and patient satisfaction were examined in relation to tumour type (i.e., cancerous vs. benign). A change in masticatory force was associated with a reduction in the number of occlusal support zones after surgery and clearly differed by tumour type. Despite all patients showing reduced masticatory force postoperatively, all were satisfied with the improvements in eating and chewing, which were greater in patients with benign tumours than in those with cancerous tumours. Although both groups of patients expressed satisfaction with the aesthetic appearance after surgery, patients with cancerous tumours were more satisfied. However, both groups showed decreased speech intelligibility scores and lower satisfaction with speech after surgery. Preoperative support in the form of reassurance and helping to alleviate anxiety about postoperative appearance would be beneficial for all patients, with additional support provided based on the specific tumour type.     

Analgesic efficacy and tolerability of diflunisal in oral surgery

A double-blind, completely randomized study was carried out on 169 patients to compare the analgesic efficacy and tolerability of diflunisal with that of Veralgin after surgical removal of impacted third molars. One group received 1000 mg diflunisal (Donobid, MSD) 2 h preoperatively and then 500 mg twice daily for 2.5 days, and the other group Veralgin (aminophenazon. 286 mg, barbital. 114 mg, aethylmorph. hydrochlorid. 20 mg, Orion), a fixed combination widely used in Finland, 1 tablet twice daily beginning 2 h prior to operation. Visual analogue scales were used to estimate pain. Diflunisal was found to be superior in relieving pain in the early postoperative period, the associated frequency of adverse clinical experiences was lower and the final evaluation of analgesic efficacy by both the patients and the investigators, was in its favour. The study confirms that postoperative pain after third molar surgery can be controlled well without the use of mainly centrally acting combination analgesics.     

Comparison of preoperative and postoperative diflunisal for suppression of postoperative pain

Despite the demonstrated therapeutic advantage of preoperatively administered nonsteroidal anti-inflammatory agents (NSAIAs) in suppressing postoperative pain, clinicians are reluctant to administer these drugs orally before surgical procedures performed using sedation or general anesthesia. Using a within-subject, crossover experimental design, this study compared the analgesic efficacies of an NSAIA, diflunisal 1,000 mg, administered either 30 minutes preoperatively or 30 minutes postoperatively to 20 patients undergoing the removal of impacted third molars. Pain intensity was assessed preoperatively and postoperatively for eight hours using category-rating and visual analog scales. Treatment with diflunisal 30 minutes after completion of surgery proved to be just as effective in suppressing postsurgical pain as presurgical administration. Administration of an NSAID in the immediate postoperative period may be indicated for optimum postoperative analgesia for patients in whom preoperative oral intake is contraindicated.     

Evaluation of ketorolac (Toradol) with varying amounts of codeine for postoperative extraction pain control

This study analyzes the combination of oral ketorolac 10 mg with varying amounts of codeine phosphate, and the postoperative pain relief that developed from these combinations. Five groups of patients were administered the codeine/ketorolac combinations. Variations of the combinations were analyzed to ascertain if an optimal analgesic ratio existed. All controllable variables involved with the surgical procedure were held constant to allow for better evaluation of postoperative pain. Results obtained from 67 patients indicated that the best pain relief was achieved with a combination of 10 mg ketorolac and 15 mg codeine phosphate. Codeine alone provided adequate analgesia, but the addition of ketorolac reduced the patients' perceived side effects. The presence of codeine in the analgesic combination was also shown to reduce the number of days that the patient required the medication postoperatively. Reducing the duration of medication use postoperatively may also minimize the possible side effects of ketorolac and codeine, which could develop with extended periods of use.     

Effects of preemptive analgesia with intravenous acetaminophen on postoperative pain relief in patients undergoing third molar surgery: a prospective,single-blind,randomized controlled trial

Background The efficacy of preemptive analgesia in managing postoperative pain remains controversial. The aim of this study was to compare the efficacy of intravenous (IV) acetaminophen administered before or immediately after the surgical extraction of an impacted mandibular third molar. Material and Methods This prospective randomized clinical trial included 120 patients. The patients were assigned to one of three groups: the preoperative-treatment group (pre-group), which received 1000 mg of IV acetaminophen 20 min before surgery; the postoperative-treatment group (post-group), which received 1000 mg of IV acetaminophen after surgery; the no-treatment group (control-group), which did not receive any analgesic. Rescue analgesic (60 mg loxoprofen) was issued to each patient, with instructions on self-administration if needed. For the rescue medication usage, the time of first loxoprofen usage and the total amount of loxoprofen consumption were obtained for a 17-hour period after surgery. We measured pain using the visual analogue scale at 1 hour and at 2, 3, 4, 5, and 15 hours after surgery. Results There was no significant difference in pain level among the three groups at any time interval. However, the pre-group demonstrated significantly lower rescue analgesic consumption and longer time until initial administration. Conclusions Administration of IV acetaminophen before third molar surgery provides more effective pain control than postoperative administration and no treatment. Key words:Preemptive analgesia, acetaminophen, impacted third molar, pain relief, randomized controlled trial.