PREEMPTIVE INTRAVENOUS IBUPROFEN AND LOCAL KETAMINE IMPROVE POSTOPERATIVE ANALGESIA FOLLOWING THIRD MOLAR SURGERY: A DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL STUDY.

OBJECTIVE: To compare the efficacy of preemptive ibuprofen, local ketamine, and their combination in managing postoperative pain and trismus following third molar surgery. MATERIALS AND METHODS: One hundred patients were randomly divided into 4 groups. The Intrafen Group had their impacted third molars surgically removed under local anesthesia after receiving intravenous (IV) ibuprofen for preemptive effect. The Ketamine Group received an IV placebo before the surgery, and the extraction process was completed with a local anesthetic-ketamine combination. The Combined Group received preemptive IV ibuprofen before the procedure, and the surgery was performed with a local anesthetic-ketamine combination. The Control Group received an IV placebo before the procedure and then had their impacted third molars removed under local anesthesia. The Visual Analogue Scale (VAS) values, corresponding to the patients' pain levels at the 2nd and 12th postoperative hours and the total amount of analgesic dose used in the first 24 hours, were recorded, and evaluated. The maximum mouth opening of the patients was measured immediately before the procedure, and on the second and seventh postoperative days. The level of patient satisfaction in all groups was assessed during the procedure. RESULTS: The mean VAS value corresponding to the second-hour pain level of the combined group was statistically significantly lower than the other groups (P = .003). A statistically significant difference was found in the mean VAS values corresponding to the pain levels of the groups, favoring the combined group compared to the other groups (P ≤ .001). A significant difference was observed between the VAS difference values corresponding to the pain levels of the Intrafen group and the Ketamine group, favoring the Intrafen group (P = .038). The Ketamine group consumed the most analgesic on average over the first 24 hours, whereas the Combined group consumed the least. No statistically significant difference was found between the mean trismus levels of the groups on days 0-2 (P = .528) and days 0-7 (P = .129). The intraoperative patient satisfaction level of the combined group was significantly higher than that of the other groups (P = .030). CONCLUSION: Preemptive Intrafen is an effective regimen for postoperative pain management and is superior to the local anesthetic-ketamine regimen. The most effective method to reduce postoperative pain following third molar surgery is to use a combination of these 2 regimens. However, none of the treatment methods used in the study had a positive effect on postoperative trismus.

Is Postoperative Pain Associated With Nausea and Vomiting Following Orthognathic Surgery?

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common adverse side-effect following orthognathic surgery, with pain potentially contributing as a risk factor. PURPOSE: The study's purpose was to measure the association between postoperative pain and PONV. STUDY DESIGN, SETTING, SAMPLE: This prospective cohort study involved patients who underwent bimaxillary surgery at Erciyes University, Oral and Maxillofacial Surgery Hospital. Patients with a history of routine antiemetic use, pregnancy, breastfeeding, morbid obesity, cardiac dysrhythmia, mental retardation, or psychiatric illness were excluded. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The predictor variable was postoperative pain, which was measured using a 100-mm visual analogue scale (VAS). VAS scores were documented at the 30-minute postoperative mark (referred to as VAS1), and the mean of hourly VAS scores over the initial three postoperative hours (denoted as VAS2). MAIN OUTCOME VARIABLE(S): The primary outcome was the occurrence of PONV, defined as active vomiting, retching, or nausea leading to vomiting. The secondary outcome was the timing of PONV, categorized as early (within 6 hours), late (6-24 hours), and delayed (beyond 24 hours postoperatively). COVARIATES: The study's covariates were age, sex, body mass index, Apfel risk scores, surgery duration, history of PONV or motion sickness, and smoking status. ANALYSES: Descriptive statistics and χ2 tests were used for data analysis, with statistical significance set at P value < .05. RESULTS: The sample was composed of 86 subjects with a median age of 20 years (range: 18-30 years), of which 37.2% were male. The frequency of PONV was 50%. Postoperative pain, as measured by VAS scores, was significantly higher in the PONV group compared to the non-PONV group. The median VAS1 score was 60.0 (PONV group, range 40-90) versus 50.0 (non-PONV, range 0-90) (P = .041); for VAS2, it was 60.0 (PONV, range 40-80) compared to 40.0 (non-PONV, range 30-60) (P < .001). CONCLUSIONS AND RELEVANCE: The frequency of PONV observed in patients undergoing bimaxillary surgery is substantial, necessitating the identification and management of risk factors to enhance perioperative care and patient outcomes. By improving PONV management and addressing postoperative pain, health-care providers can enhance the perioperative experience and patient outcomes in bimaxillary surgery.

Effectiveness Of Computed Tomography-Guided Nasotracheal Intubation Procedure On Predicting Tube Advancement Difficulty And Preventing Epistaxis: A Prospective Case-Control Study.

Objectives: To evaluate the effectiveness of computed tomography-guided nasotracheal intubation procedure in predicting tube advancement difficulty and preventing epistaxis. METHODS: The prospective study was conducted at Erciyes University Faculty of Dentistry from April 2018 to June 2019 and comprised maxillofacial surgery patients of either gender aged 18-50 years who were due to undergo bimaxillary orthognathic surgery, which was defined as American Society of Anaesthesiology grade I or II. The space where the tube was to be passed in the internal nasal valve region was measured horizontally and vertically using computed tomography. A single experienced anaesthesiologists intubated all the patients who were later divided into 'easy' group A and 'difficult' group B on the basis of the effort required to advance the tube through the nasal passage. Data was analysed using JASP version 0.14.1.0). RESULTS: Of the 60 patients, 42(70%) were females and 18(30%) were males. The overall mean age was 29.0±10.5 years and the mean body mass index value was 23.6±4.0 kg/m 2 (p>0.05). There were 28(46.6%) patients in group A, and 32(53.3%) in group B. Median distances were significantly shorter and epistaxis was significantly higher in group B compared to group A (p<0.001). The cut-off values to reveal the distance at which difficulty may be experienced while advancing the tube, determined through receiver operating characteristic analysis, were 1.09 cm for vertical and 0.39cm for horizontal distances. CONCLUSIONS: The nasotracheal intubation procedure under the guidance of computed tomography could help predict the difficulty of tube advancement, and could thus prevent epistaxis and other related nasal intubation complications. Clinical trial number: NCT05525754.

Effect of platelet indices on postoperative pain and edema in bimaxillary surgery.

OBJECTIVES: To investigate the influence of platelet volume indices (PVI) on postoperative pain and edema in patients undergoing bimaxillary surgery and assessed the associations between PVI parameters and other clinical factors. METHODS: We examined the medical records of 50 patients aged 18-40, treated between 2019 and 2020. Platelet indices (platelet count [PLT]), mean platelet volume, platelet distribution width, plateletcrit (PCT), and platelet large cell ratio) were analyzed. Postoperative pain and edema were assessed based on the frequency of intravenous (IV) analgesic administration and 3D imaging. A lasso-penalized regression was used for the analysis. RESULTS: Significant positive correlations were observed between PLT and postoperative edema on the first (T1-0) and third (T3-0) postoperative days. Furthermore, PLT was positively associated with the number of IV analgesic drug administrations from 24 to 72 hours after surgery. Additionally, a discernible positive correlation was identified between PCT levels and the quantity of IV analgesic drugs administered within the first 24 hours after surgery. CONCLUSION: Platelet indices, particularly PLT and PCT levels, were associated with postoperative pain and edema in patients undergoing bimaxillary surgery. These indices have the potential to serve as biomarkers for predicting and managing postoperative complications of orthognathic surgery. Further studies are required to explore the clinical utility and implications of these findings.

Does preventive single dose of intravenous dexketoprofen reduce pain and swelling after orthognathic surgery? A prospective, randomized, double blind clinical trial

Background: The purpose of this study was to evaluate the effect of a single-dose intravenous dexketoprofen administration for preventive analgesia on postoperative pain and reducing swelling in double jaw surgery. Material and methods: The authors designed a prospective, randomized, and double-blind cohort study. Patients who have Class III malocclusion were randomly divided in two groups. 50 mg intravenous dexketoprofen trometamol were administrated 30 minutes before incision in treatment group, while intravenous sterile saline was administrated 30 minutes before incision in placebo group. The primary predictor variable was treatment group. Primary outcomes were pain, swelling and 24-hour opioid intake. Patient- controlled analgesia with tramadol was given for management of postoperative pain. Other variables were demographic and operation related parameters. Visual analogue scale was used to evaluate postoperative pain. 3dMD Face System (3dMD, USA) was used to measure postoperative swelling. Data were analysed using two independent samples t test and Mann Whitney U test. Results: The study sample was composed of 30 patients with a mean age of 20,63 years and 21 were female. Preemptive dexketoprofen administration decreased postoperative tramadol consumption by 25.9% compared to placebo group, and there was a statistically significant decrease in VAS scores (p<0,05). There was no statistically significant difference between the groups in terms of swelling (p>0,05). Conclusions: Preventive administration of intravenous dexketoprofen provides adequate analgesic effect in the postoperative 24-hour period and reduces opioid consumption in orthognathic surgery. (AU)

Does a Nasal Airway Facilitate Nasotracheal Intubation or Not? A Prospective, Randomized, and Controlled Study.

PURPOSE: Nasotracheal intubation (NTI) is generally preferred for maxillofacial surgery to provide a more suitable and wide surgery area for the surgeons. The purpose of the study was to evaluate whether using a nasal airway just before the NTI may facilitate NTI or not. METHODS: This prospective, randomized, and controlled study was performed on patients who were admitted to our hospital for maxillofacial surgery. In group 1, a nasal airway was used just before the NTI during mask ventilation, and patients in the group were ventilated without nasal airway. Airway group was the primary predictor of the study. The NTI duration was the primary outcome variable, and the number of attempts was the secondary outcome variable. Difficulty of ventilation and complications were the other variables that were recorded. RESULTS: A total of 70 patients were included in the study and divided into 2 groups. There was no statistically significant relationship between the duration of NTI and other variables, but the significance value for sternomental distance, ventilation difficulty, and epistaxis was P < .10. The NTI duration (the primary outcome variable) and the number of attempts (the secondary outcome variable) are statistically lower in the nasal airway group (group 1) than the control group (group 2). Ventilation difficulty was significantly higher in group 2 when compared with group 1 (P = .04). The model and regression coefficients for both variables are statistically significant in terms of duration of NTI and number of attempt values that they were lower in nasal airway group than the control group. There were no statistically significant differences between the groups in terms of complications (P < .05). CONCLUSIONS: The present study has shown that inserting a nasal airway into the nostril just before the NTI may facilitate the intubation process by preparing the nasal passage.

Using Intravenous Ibuprofen for Preventive Analgesia in Orthognathic Surgery.

PURPOSE: Preventive analgesia aims to manage postoperative pain caused by nociceptive and central stimulation. The purpose of this study was to research the effect of a single-dose intravenous (IV) ibuprofen administration for preventive analgesia on postoperative pain management in orthognathic surgery. MATERIALS AND METHODS: This prospective, double blind, and randomized study was performed on a total of 40 adult patients who planned to undergo bimaxillary osteotomy, between 2018 and 2019. Thirty minutes before the surgery, 800 mg of IV ibuprofen and 100 mL of saline were applied to group 1 (ibuprofen; n = 20) and group 2 (placebo; n = 20), respectively. Postoperative analgesia was maintained with tramadol infusion via a patient-controlled analgesia pump. Postoperative visual analog scale (VAS) scores at 1, 3, 6, 9, 12, and 24 hours after surgery, rescue analgesic requirement, total tramadol dose, and adverse effects were recorded. RESULTS: VAS scores between the groups at 1, 6, 9, and 24 hours and also the average of 24-hour VAS scores were similar (P > .05). However, VAS scores at 3 hours were significantly higher in group 2 (P = 0.06). Also, rescue analgesic intake of paracetamol was significantly higher in group 2 in the third hour (P = .08). Rescue analgesic intake of paracetamol and tramadol consumption during the postoperative 24 hours were similar (P > .05). CONCLUSIONS: Using single-dose IV ibuprofen administration just before orthognathic surgery for preventive analgesia reduced VAS scores and postoperative opioid consumption in patients. However, further studies in a large population are needed to estimate the preventive analgesia effect of ibuprofen in orthognathic surgery.

Does Single-Dose Preemptive Intravenous Ibuprofen Reduce Postoperative Pain After Third Molar Surgery? A Prospective, Randomized, Double-Blind Clinical Study.

PURPOSE: The aim of the present study was to identify the preemptive analgesic effect of intravenous (IV) ibuprofen before and after mandibular third molar surgery. MATERIALS AND METHODS: We randomly divided 75 patients into 3 groups. Group 1 received IV ibuprofen 60 minutes before surgery and IV placebo (100 mL of saline) after surgery. Group 2 received IV placebo (100 mL of saline) before surgery and IV ibuprofen 60 minutes after surgery. Finally, group 3 received IV placebo (100 mL of saline) 60 minutes before and after surgery. Postoperative pain was recorded using a visual analog scale at 1, 2, 4, 6, 8, 12, and 24 hours within the postoperative period. The total dose of rescue acetaminophen intake was recorded during the first 24 hours of the postoperative period. RESULTS: The efficacy of postoperative analgesia was greater within the preoperative IV ibuprofen group compared with the other groups (P < .001). The placebo group had required more rescue analgesia within the first hour compared with the other groups. The average dose of acetaminophen administered in group 1 was 640 mg compared with 1240 mg in group 2 and 1840 mg in group 3 within the first 24 hours after surgery (P < .001). CONCLUSIONS: The present study has shown that the preemptive use of IV ibuprofen resulted in less pain and a decrease in the requirement for rescue analgesia during the first 24 hours after third molar surgery.

The effect of mouth prop on endotracheal tube intracuff pressure in children during dental rehabilitation under general anaesthesia.

Although the endotracheal tube (ETT) cuff may be associated with tracheal morbidity, cuffed tubes may reduce the aspiration risk in oral procedures. Dentists must use a mouth prop to facilitate oral visualization and to protect the oral soft tissues during dental rehabilitation under general anaesthesia (DRGA). The aim of this study was to evaluate the effect of mouth prop on endotracheal tube intracuff pressure in children during DRGA. Two-hundred and three ASA I-II patients, <18 years of age (mean: 5.3 ± 2.4 years) were included in the prospective observational study whose comprehensive dental treatment was performed under general anaesthesia. Following the induction of general anaesthesia, placement of a cuffed endotracheal tube which was an appropriate size for children was fixed. The intracuff pressure was measured intermittently after the intubation (baseline) (T0), immediately after the mouth prop (T1), 30 min after the mouth prop (T2), after taking out the mouth prop (T3) and just before extubation (T4). The mean intracuff pressure was 28.3 ± 2.01 cm H2O at T0. The mean intracuff pressure significantly increased at T1 (30.8 ± 2.7) and T2 (29.6 ± 3.7) compared to T0 (P < 0.001). No significant differences were observed between the duration of the procedure and intracuff pressure or postoperative complications (P > 0.05). Cough, sore throat and nausea were observed in 4, 1 and 5 patients, respectively. Because a mouth prop may increase the intracuff pressure of ETT, strict measurement and readjustment of cuff pressures should be employed when used in children during DRGA.

Comparison of ketamine-propofol and ketamine-dexmedetomidine combinations in children for sedation during tooth extraction.

OBJECTIVE: To evaluate the efficiency of ketamine-propofol and ketamine-dexmedetomidine drugs in children for sedation during tooth extraction. METHODS: The randomised, prospective study was conducted at the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erciyes University, Kayseri, Turkey, from September to November 2013, and comprised children who were due to undergo tooth extraction. Non-invasive blood pressures (systolic and diastolic), peripheral oxygen saturation, heart and respiratory rates and Ramsay Sedation Scores were assessed at baseline, after applying the drugs and then every 5 minutes thereafter. Further, the ketamine-propofol group received 1mg kg-1 of ketamine and propofol, and the ketamine-dexmedetomidine group received 1mg kg-1 of ketamine + 0.5 µg kg1 of dexmedetomidine. RESULTS: Of the 60 participants, there were 30 (50%) in each group. No statistically significant differences were found in terms of heart rate, non-invasive blood pressures at any time and the number of drug repetitions (p>0.05). Nausea-vomiting was statistically higher in the ketamine-dexmedetomidine group (p<0.05). CONCLUSIONS: Ketamine-propofol might be a better option due to lower vomiting and nausea episodes and higher surgeon satisfaction levels.

Comparison of Ozone and Photo-Biomodulation Therapies on Mental Nerve Injury in Rats.

PURPOSE: This study compared photo-biomodulation (PBM) and ozone therapy (OT) for mental nerve injury by counting Schwann cells (SCs) and fasciculated nerve branches and measuring fascicular nerve areas. MATERIALS AND METHODS: The effects of OT and PBM on mental nerve injury were evaluated. Mental nerves of 27 rats were partly sutured and allocated into 3 groups. Group 1 received no treatment, group 2 received OT, and group 3 received PBM. The number of fascicules beyond nerve branches and the number of SCs before and after nerve injury were evaluated histologically. RESULTS: A better healing pattern was observed in the treatment groups. The number of SCs was markedly larger in the OT and PBM groups than in the control group. CONCLUSIONS: Oral and maxillofacial surgeons should be familiar with the differential diagnosis, prevention, and management of neurosensory disturbances. This study provides insights into the management of neurosensory disturbances related to mental nerve injury using OT and PBM. This study clearly suggests that OT and PBM are promising novel methods for the treatment of mental nerve injury.

Intravenous ketamine, propofol and propofol-ketamine combination used for pediatric dental sedation: A randomized clinical study.

BACKGROUND AND OBJECTIVE: Dental treatments cannot bealways performed under local anesthesia inpediatric non-cooperative patients. For this purpose, differentanesthetic techniques have been applied to increase patient comport to dental treatments. METHODS: Sixty children classified as ASA I-II, between aged 3 to 9, who were scheduled to undergo tooth extraction, were enrolled for this randomized study. Group K received 1 mg/kg ketamine, Group P received 1 mg/kg propofol, and Group KP received 0.5 mg/kg propofol plus 0.5 mg/kg ketamine intravenously for anesthesia induction. RESULTS: Recovery time was significantly lower in Group P than Group KP. No significant differences were found between groups regarding HR, before and after the induction, at tenth minute. Fifth minute's HR was higher in Group K than Group KP. Mean arterial pressure (MAP) values were similar at baseline, before and after the induction, and at tenth minute, whereas significantly lower values were found in Group P and Group KP than in Group K at fifth minute. CONCLUSIONS: Although ketamine, propofol and ketamine-propofol combination are effective for sedation in tooth extraction in pediatric patients, propofol may be an excellent alternative, with the shortest recovery, no nausea and vomiting, and reasonable surgical satisfaction.

Evaluation of effectiveness of the using a pillow in children for dental rehabilitation under general anesthesia in term for facilitate intubation.

BACKGROUND AND OBJECTIVE: Airway safety may be provided with endotracheal intubation especially for oral procedures because of some potential risks such as aspiration of secretion or foreign bodies. In this study, we aimed to determine whether placing a pillow under the occiput may facilitate endotracheal intubation in non-cooperative children whose extensive dental treatments were planned to take place under general anesthesia. METHODS: The study was performed in Erciyes University, Faculty of Dentistry between March-July 2014. A total 150 ASA I-II children, between 3-9 years were included in this study. Pillow was folded under the occiput in Group 1 (n=75), patients lay on a flat surface in Group 2 (n=75) during the anesthesia induction and intubation period. RESULTS: There were no statistically significant differences between groups regarding the demographic data (age, weight, gender) (p>0.05). Operation times were similar in both groups (p=0.329). The number of intubation attempts was smilar in both groups (p=0.412). The intubation time was longer in group one than in group two (p= 0.025). CONCLUSION: We concluded that, placing a pillow under the patients occiput provided longer intubation time without changing the number of attempts in the normal airway in non-cooperative children whose extensive dental treatments were planned to take place under general anesthesia.

Comparison of Effects of Different Dexmedetomidine and Chloral Hydrate Doses Used in Sedation on Electroencephalography in Pediatric Patients.

The aim of this study was to compare the efficacy and safety of different oral chloral hydrate and dexmedetomidine doses used for sedation during electroencephalography (EEG) in children. One hundred sixty children aged 1 to 9 years with American Society of Anesthesiologists physical status I-II who were uncooperative during EEG recording or who were referred to our electrodiagnostic unit for sleep EEG were included to the study. The patients were randomly assigned into 4 groups. In groups D1 and D2, patients received oral dexmedetomidine doses of 2 and 3 µg/kg, respectively. In group C1 and C2, patients received oral chloral hydrate doses of 50 and 100 mg/kg, respectively. The induction time was significantly shorter in group C2 compared with other groups (P = .000). The rate of adverse effects was significantly higher in group C2 compared with the dexmedetomidine groups (D1 and D2; P = .004). In conclusion, dexmedetomidine can be used safely for sedation during EEG in children.

Ketamine-propofol vs ketamine-dexmedetomidine combinations in pediatric patients undergoing burn dressing changes.

The aim of this study was to compare ketamine-propofol (KP) and ketamine-dexmedetomidine (KD) combinations for deep sedation and analgesia during pediatric burn wound dressing changes. After obtaining approval from the University Ethics Committee, burn wound care or wound dressing changes were performed on 60 American Society of Anesthesiologists physical status I and II inpatients aged between 8 and 60 months with second-degree burns ranging from 5 to 25% TBSA. After recording the demographic data, the heart rate, systolic arterial pressure, diastolic arterial pressure, peripheral oxygen saturation, respiratory rate, and Ramsey sedation scores were recorded for all patients before and during the procedure. Group KP (n = 30) received 1 mg kg⁻¹ ketamine + 1 mg kg⁻¹ propofol and group KD (n = 30) received 1 mg kg⁻¹ ketamine + 0.5 µg kg⁻¹ dexmedetomidine for induction. Additional propofol (1 mg kg⁻¹) for group KP and additional dexmedetomidine (0.5 µg kg⁻¹) for group KD were administered when required. No statistically significant differences in sedation scores and peripheral oxygen saturation and diastolic arterial pressure (P > .05) were found between the two groups. However, systolic blood pressure values in group KD showed a significant increase after induction (P < .05). The recovery time was longer in group KD than in group KP (P < .05). The respiratory rate was higher in group KD than in group KP beginning from the fifth minute of the procedure. A significant amount of respiratory depression and hypoxia was observed in group KP but not in KD (P < .05). Both the KP and KD combinations were effective for sedation and analgesia during dressing changes in the pediatric burn patients. The KD combination can be considered as an excellent alternative for pediatric wound dressing changes which does not result in respiratory depression.

The efficiency of pulsed radiofrequency application on L5 and l6 dorsal roots in rabbits developing neuropathic pain.

BACKGROUND: Injury of a peripheral nerve may lead to neuropathic pain, a form of chronic pain that does not respond to traditional pain therapies. The aim of this study was to investigate the effect of pulsed radiofrequency (PRF) applied to the L5 and L6 dorsal roots on the neuropathic pain that develops after sciatic nerve injury in rabbits. METHODS: In this study, 18 New Zealand rabbits were used. These were divided into 3 groups. In groups 1 and 2, the left sciatic nerve was tightly ligated as a partial ligation model with 4-0 silk sutures. Group 3 was a sham group. Pulsed radiofrequency was applied to group 1 rabbits on both dorsal roots at 42 degrees C for 8 mins. The responses of all the groups to thermal and mechanical stimuli were measured for a period of 4 weeks after this process. RESULTS: Ten days after ligation of the left sciatic nerve and before PRF application, neuropathic pain occurred; the responses of groups 1 and 2 to the hot plate test and to the mechanical stimulus were lower (P < 0.005) when compared with the baseline values. There were no statistically significant differences between baseline values and group 1 rabbits' responses to the hot plate test 2 weeks after the application of PRF or to the mechanical stimulus 3 weeks after RF application. The decrease seen in group 2 persisted after 4 weeks (P < 0.001). CONCLUSIONS: The hyperalgesia that develops as a result of neuropathic pain in rabbits was observed to be reduced by PRF application.