Anaesthesia in jaw and face surgery linked to postoperative pain

The drugs propofol and remifentanil are anesthetics used for limiting blood loss, avoiding respiratory depression, and averting postoperative nausea and vomiting in patients undergoing orthognathic (jaw and face) surgery. However, patients may subsequently experience more postoperative pain.

The journal Anesthesia Progress presents a retrospective study of 51 patients, in which 21 of the orthognathic maxillofacial surgery patients in the group receiving intravenous propofol and remifentanil experienced significantly higher pain scores. Anesthesia for the 30 patients in the comparison group was maintained with inhalational agents and longer-acting opioids.

The drug remifentanil is seeing increased use because its short half-life can facilitate stable operating conditions while avoiding the undesirable postoperative consequences of agents such as morphine. There is still a need for pain control in the postoperative period using longer-acting opioids.

Variables of comparison included recovery time, occurrence of nausea and vomiting, pain scores, heart rate, and opioid dose administered in the 4 hours following surgery.

There was a trend toward shorter recovery times in the group receiving propofol and remifentanil, with a median recovery time of 65 minutes compared to 93 minutes for the inhalation group. However, the first group reported higher pain scores in the first 4 hours following surgery. No differences were found in early postoperative opioid use, heart rate, or nausea and vomiting.