While the use of propofol and remifentanil are increasing in orthognathic surgery, patients may experience more postoperative pain than with other types of anesthesia, according to a study in Anesthesia Progress (Summer 2012, Vol. 59: 2, pp. 69-74).
Remifentanil is increasingly used in orthognathic surgery because its short half-life can facilitate stable operating conditions while avoiding the undesirable postoperative consequences of morphine and other such agents, according to lead author Soudeh Chegini, from Heatherwood and Wexham Park Hospitals NHS Foundation Trust, and colleagues. There is still a need for pain control in the postoperative period using longer-acting opioids that carry a greater potential for adverse effects, they noted.
In a retrospective study of 51 patients who underwent procedures at Oxford Radcliffe Hospitals, 21 patients received intravenous propofol and remifentanil. Anesthesia for the 30 patients in the comparison group was maintained with inhalational agents and longer-acting opioids.
The study was undertaken to ensure that achieving better intraoperative conditions did not come at the expense of patients' recovery, according to the authors. Variables of comparison included recovery time, occurrence of nausea and vomiting, pain scores, heart rate, and opioid dose administered in the four hours following surgery.
There was a trend toward shorter recovery times in the group receiving propofol and remifentanil; the median recovery time was 65 minutes for this group and 93 minutes for the inhalation group. However, the propofol/remifentanil group also reported higher pain scores in the first four hours following surgery. No differences were found in early postoperative opioid use, heart rate, or nausea and vomiting.
