Single Dose Intravenous Paracetamol versus Placebo in Postorthognathic Surgery Pain: A Randomized Clinical Trial.

Background: The postorthognathic surgery patients experienced moderate to severe pain and could be at risk for opioid-related side effects. The aim of this study was to evaluate the efficacy of a single dose of intravenous paracetamol to control postorthognathic surgery pain and reduce opioid consumption. Methods: The patients were randomized into two groups. The study group received intravenous paracetamol and the control group received a placebo immediately postoperation. The visual analogue pain scale (VAS) at 1-, 4-, 8-, 12-, 16-, 20-, and 24 -h postoperatively, morphine consumption, side effects from morphine, and patient satisfaction were analyzed. Results: Sixty-two patients (thirty-one patients in each group) were included. The postoperative VAS in the study group was significantly lower than those in the control group (p value <0.001) at all time points. The total postoperative morphine consumption in the study group (45.1 ± 21.2 mcg/kg) was significantly lower compared with the control group (136.5 ± 49.9 mcg/kg) (p value <0.001). Patient satisfaction was significantly higher in the study group (4.7 ± 0.5 out of 5 points) than in the control group (4.1 ± 0.7 out of 5 points) (p value <0.001). The incidence of nausea and vomiting was significantly lower in the study group compared with the control group (p value <0.001 and 0.002, respectively). Conclusion: A single dose of intravenous paracetamol as part of multimodal analgesia was effective for postorthognathic surgery pain. It provided significant benefits to patients, including reduced pain scores, decreased opioid consumption, reduced nausea and vomiting, and improved satisfaction. This trial is registered with TCTR20210908002.

Sudden Cardiac Arrest in a Dental Patient Awaiting Examination.

Sudden cardiac arrest (SCA) is an uncommon event in dental practice; however, the frequency of dentists encountering SCA and other major medical emergencies is increasing. We report the successful resuscitation of a patient who developed SCA while awaiting examination and treatment at a dental hospital. The emergency response team was called upon, and cardiopulmonary resuscitation/basic life support (CPR/BLS), including chest compression and mask ventilation, was promptly initiated. An automated external defibrillator was used, which indicated that the patient's cardiac rhythm was unsuitable for electrical defibrillation. The patient returned to spontaneous circulation after 3 cycles of CPR and intravenous epinephrine. The knowledge and skill levels of dentists regarding resuscitation under emergency circumstances should be addressed. Emergency response systems must be well established, and CPR/BLS knowledge and training should be updated regularly, including optimal management of both shockable and nonshockable rhythms.

Perioperative Management of a Patient With Tongue Cancer Who Developed Pneumomediastinum Following Tracheostomy Performed to Secure the Airway.

Prior to a scheduled operation for a 45-year-old male patient with tongue cancer, a tracheotomy performed under intravenous sedation to prevent asphyxia due to extensive bleeding resulted in pneumomediastinum and subcutaneous emphysema. The planned operations were postponed until reduction of the pneumomediastinum was confirmed. During operation, airway pressure was kept low to prevent tension pneumomediastinum along with a sufficient depth of anesthesia, controlled analgesia, and continuous administration of muscle relaxants. Postoperatively, sedation was used to avoid stress and complications with the vascular anastomosis site. In this case, air leakage into the soft tissues was one of the possible causes of the event associated with increased airway pressure. Although the incidence of such complications is relatively low, caution should be exercised after tracheostomy.

Does Ultrasound-Guided Transversus Abdominis Plane Block Reduce Donor Site Pain After Harvesting Anterior Iliac Crest Bone Grafts.

PURPOSE: The most common side-effect of anterior iliac crest (AIC) bone grafting is postoperative pain. The purpose of this study was to investigate the effectiveness of ultrasound-guided transversus abdominis plane (TAP) block for reducing donor site pain after harvesting AIC bone graft. METHODS: Patients scheduled for unilateral alveolar cleft repair with AIC bone grafting, regardless of age, were enrolled in this prospective, randomized controlled trial study, divided into 2 groups: group T (performing TAP block) and group C (without TAP block). Postoperative pain at the alveolar cleft and AIC site were assessed using a visual analog scale (VAS) at the immediate postoperative time, 6, 12, and 24 hours after surgery. Morphine consumption during operation, postoperatively in the first 24 hours and total dosage until discharge and its side effects were also observed. Patients' satisfaction was accessed. MANOVA was used to evaluate the effects of treatment on those outcome variables. The P value <.05 was considered statistically significant. RESULTS: Eighteen patients, with a mean age of 14.39 ± 3.70 years, were enrolled in this study. Pain scores at the AIC site in group T were statistically less significant than in group C for all times with P value <.001, <0.001, 0.002, and 0.004 consequently. Pain scores at the AIC site at 24 hours had no statistically significant difference after Bonferroni correction. There was statistically significant greater patients' satisfaction in pain control at the AIC site in group T than in group C with P value <.001. Group T revealed, statistically significant, less morphine consumption than group C at both the first 24 hours and postoperatively, totally until discharge with P value <.001. No complications of TAP block were reported in this study. There was a statistically significant lower incidence of nausea in group T than in group C with P value 0.029. CONCLUSIONS: The ultrasound-guided TAP block is an effective postoperative pain controller and can decrease postoperative morphine consumption at AIC bone harvesting.

Risk factors for ala nasi pressure sores after general anesthesia with nasotracheal intubation.

PURPOSE: To prospectively investigate the risk factors that associate to ala nasi pressure sores after general anesthesia with nasotracheal intubation. MATERIAL AND METHOD: All Patients underwent oral and maxillofacial surgeries during May 2018 to December 2018 were enrolled in this prospective study. Alae nasi were evaluated after finishing of the operation under general anesthesia with nasotracheal intubation for having pressure sore or not. The seven suspected risk factors were investigated for evaluation of the significant association with ala nasi pressure sores. Descriptive, univariate, and multivariate statistics were computed, and the P value was set at .05. RESULTS: One hundred and fifty-five patients were enrolled. The incident of ala nasi pressure sore after general anesthesia with nasotracheal intubation was 21.45% in duration of six months. Risk factors associated with ala nasi pressure sore with univariate analysis were long duration of surgery, and lack of hydrocolloid dressing. After multivariate analysis, the significant risk factors for ala nasi pressure sores after general anesthesia with nasotracheal intubation were long duration of surgery (OR 1.005, 95%CI 1.002 to 1.009, p = 0.004), and lack of hydrocolloid dressing (OR 9.934, 95%CI 3.347 to 29.489, p < 0.001). While the significant protective factor was higher body mass index (OR 0.864, 95% CI 0.749 to 0.997, p = 0.045). CONCLUSION: Long duration of surgery and lack of hydrocolloid dressing are significant risk factors for ala nasi pressure sores after general anesthesia with nasotracheal intubation. While high body mass index is significant protective factor. Shortening the duration of surgery and using of hydrocolloid dressing between ala nasi and the nasotracheal tube or catheters that inserted via nose, such as nasogastric tube, are strongly recommended.