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Factors that affect intravenous patient-controlled analgesia for postoperative pain following orthognathic surgery for mandibular prognathism.

Aoki Y, Yoshida K, Nishizawa D, Kasai S, Ichinohe T, Ikeda K, Fukuda K - PLoS ONE (2014)

Bottom Line: A significant difference in the time course of fentanyl administration was found (P<0.001).A significant difference in the time course of fentanyl administration was found between surgical methods, such as bilateral mandibular sagittal split ramus osteotomy (BSSRO) and BSSRO combined with Le Fort I osteotomy (bimaxillary; P = 0.008), with no interaction between time course and surgical method (P = 0.535).Total postoperative 24 h consumption associated with the bimaxillary procedure was significantly higher than with BSSRO (P = 0.008).

View Article: PubMed Central - PubMed

Affiliation: Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.

ABSTRACT
The predictors of postoperative pain and analgesic consumption were previously found to include preoperative pain, anxiety, age, type of surgery, and genotype, but remaining unclear was whether intraoperative factors could predict postoperative pain. In the present study, we investigated the time-course of fentanyl consumption using intravenous patient-controlled analgesia records from patients who underwent orthognathic surgery for mandibular prognathism and analyzed the influence of anesthesia methods and surgical methods together with sex on the time course. A significant difference in the time course of fentanyl administration was found (P<0.001). No significant difference in the time course of fentanyl administration was found between males and females (P = 0.653), with no interaction between time course and sex (P = 0.567). No significant difference in the time course of fentanyl administration was found among anesthesia methods, such as fentanyl induction followed by fentanyl maintenance, fentanyl induction followed by remifentanil maintenance, and remifentanil induction followed by remifentanil maintenance (P = 0.512), but an interaction between time course and anesthesia method was observed (P = 0.004). A significant difference in the time course of fentanyl administration was found between surgical methods, such as bilateral mandibular sagittal split ramus osteotomy (BSSRO) and BSSRO combined with Le Fort I osteotomy (bimaxillary; P = 0.008), with no interaction between time course and surgical method (P = 0.535). Total postoperative 24 h consumption associated with the bimaxillary procedure was significantly higher than with BSSRO (P = 0.008). The present results indicate that administration patterns and total 24 h consumption were different among the three groups of anesthesia methods and between the two groups of surgical methods, respectively. Although more research on patient-controlled analgesia patterns and consumption is necessary, the present study will contribute to adequately relieving individual patients from postoperative pain.

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Differences in the time course of fentanyl administration among anesthesia methods.Main effects, interactions, and differences within time courses were analyzed using mixed-design ANOVA (one-way for independent groups and repeated-measures with Huynh-Feldt correction). F-F, fentanyl induction followed by fentanyl maintenance; F-R, fentanyl induction followed by remifentanil maintenance; R-R, remifentanil induction followed by remifentanil maintenance. The values indicate the medians. †P<0.05, compared with fentanyl consumption in the first 2 h; *P<0.05, significant difference among the three groups in 2 h fentanyl consumption.
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pone-0098548-g002: Differences in the time course of fentanyl administration among anesthesia methods.Main effects, interactions, and differences within time courses were analyzed using mixed-design ANOVA (one-way for independent groups and repeated-measures with Huynh-Feldt correction). F-F, fentanyl induction followed by fentanyl maintenance; F-R, fentanyl induction followed by remifentanil maintenance; R-R, remifentanil induction followed by remifentanil maintenance. The values indicate the medians. †P<0.05, compared with fentanyl consumption in the first 2 h; *P<0.05, significant difference among the three groups in 2 h fentanyl consumption.

Mentions: A significant difference was found in the time course of fentanyl administration (F6.661,932.489 = 24.653, MSe = 0.157, P<0.001, Huynh-Feldt). In the time course, 2 h consumption significantly decreased from 6 h to 24 h after the end of anesthesia compared with consumption in the first 2 h (Fig. 2). No significant difference was found in fentanyl administration among the anesthesia methods (F2,140 = 0.672, MSe = 0.592, P = 0.512, Huynh-Feldt), but a significant time course × anesthesia method interaction was observed (F13.321,932.489 = 2.359, MSe = 0.157, P = 0.004, Huynh-Feldt). Consumption in the first 2 h in the R-R group was significantly higher than in the F-F group, but 8 h consumption in the R-R and F-R groups was significantly lower than in the F-F group. Nevertheless, total postoperative 24 h consumption was not significantly different among the three groups (Table 2; F2,141 = 0.672, MSe = 7.108, P = 0.512).


Factors that affect intravenous patient-controlled analgesia for postoperative pain following orthognathic surgery for mandibular prognathism.

Aoki Y, Yoshida K, Nishizawa D, Kasai S, Ichinohe T, Ikeda K, Fukuda K - PLoS ONE (2014)

Differences in the time course of fentanyl administration among anesthesia methods.Main effects, interactions, and differences within time courses were analyzed using mixed-design ANOVA (one-way for independent groups and repeated-measures with Huynh-Feldt correction). F-F, fentanyl induction followed by fentanyl maintenance; F-R, fentanyl induction followed by remifentanil maintenance; R-R, remifentanil induction followed by remifentanil maintenance. The values indicate the medians. †P<0.05, compared with fentanyl consumption in the first 2 h; *P<0.05, significant difference among the three groups in 2 h fentanyl consumption.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4043772&req=5

pone-0098548-g002: Differences in the time course of fentanyl administration among anesthesia methods.Main effects, interactions, and differences within time courses were analyzed using mixed-design ANOVA (one-way for independent groups and repeated-measures with Huynh-Feldt correction). F-F, fentanyl induction followed by fentanyl maintenance; F-R, fentanyl induction followed by remifentanil maintenance; R-R, remifentanil induction followed by remifentanil maintenance. The values indicate the medians. †P<0.05, compared with fentanyl consumption in the first 2 h; *P<0.05, significant difference among the three groups in 2 h fentanyl consumption.
Mentions: A significant difference was found in the time course of fentanyl administration (F6.661,932.489 = 24.653, MSe = 0.157, P<0.001, Huynh-Feldt). In the time course, 2 h consumption significantly decreased from 6 h to 24 h after the end of anesthesia compared with consumption in the first 2 h (Fig. 2). No significant difference was found in fentanyl administration among the anesthesia methods (F2,140 = 0.672, MSe = 0.592, P = 0.512, Huynh-Feldt), but a significant time course × anesthesia method interaction was observed (F13.321,932.489 = 2.359, MSe = 0.157, P = 0.004, Huynh-Feldt). Consumption in the first 2 h in the R-R group was significantly higher than in the F-F group, but 8 h consumption in the R-R and F-R groups was significantly lower than in the F-F group. Nevertheless, total postoperative 24 h consumption was not significantly different among the three groups (Table 2; F2,141 = 0.672, MSe = 7.108, P = 0.512).

Bottom Line: A significant difference in the time course of fentanyl administration was found (P<0.001).A significant difference in the time course of fentanyl administration was found between surgical methods, such as bilateral mandibular sagittal split ramus osteotomy (BSSRO) and BSSRO combined with Le Fort I osteotomy (bimaxillary; P = 0.008), with no interaction between time course and surgical method (P = 0.535).Total postoperative 24 h consumption associated with the bimaxillary procedure was significantly higher than with BSSRO (P = 0.008).

View Article: PubMed Central - PubMed

Affiliation: Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.

ABSTRACT
The predictors of postoperative pain and analgesic consumption were previously found to include preoperative pain, anxiety, age, type of surgery, and genotype, but remaining unclear was whether intraoperative factors could predict postoperative pain. In the present study, we investigated the time-course of fentanyl consumption using intravenous patient-controlled analgesia records from patients who underwent orthognathic surgery for mandibular prognathism and analyzed the influence of anesthesia methods and surgical methods together with sex on the time course. A significant difference in the time course of fentanyl administration was found (P<0.001). No significant difference in the time course of fentanyl administration was found between males and females (P = 0.653), with no interaction between time course and sex (P = 0.567). No significant difference in the time course of fentanyl administration was found among anesthesia methods, such as fentanyl induction followed by fentanyl maintenance, fentanyl induction followed by remifentanil maintenance, and remifentanil induction followed by remifentanil maintenance (P = 0.512), but an interaction between time course and anesthesia method was observed (P = 0.004). A significant difference in the time course of fentanyl administration was found between surgical methods, such as bilateral mandibular sagittal split ramus osteotomy (BSSRO) and BSSRO combined with Le Fort I osteotomy (bimaxillary; P = 0.008), with no interaction between time course and surgical method (P = 0.535). Total postoperative 24 h consumption associated with the bimaxillary procedure was significantly higher than with BSSRO (P = 0.008). The present results indicate that administration patterns and total 24 h consumption were different among the three groups of anesthesia methods and between the two groups of surgical methods, respectively. Although more research on patient-controlled analgesia patterns and consumption is necessary, the present study will contribute to adequately relieving individual patients from postoperative pain.

Show MeSH
Related in: MedlinePlus