Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2025
Does Dexmedetomidine Affect Opioid Consumption Following Orthognathic Surgery?
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Champion Allen F, Lee Jung-Me, Taub Daniel, Lee Yu Jin
Аннотация
BACKGROUND: Despite its purported analgesic effects, controversy exists regarding dexmedetomidine's efficacy as an opioid-sparing anesthetic adjunct.
PURPOSE: The purpose of this study is to measure the association between dexmedetomidine (DEX) administration during orthognathic surgery and postoperative opioid consumption.
STUDY DESIGN, SAMPLE, AND SETTING: A single-blind randomized prospective cohort study was implemented. Patients consenting for orthognathic surgery at Thomas Jefferson University from January 2022 to October 2024 were screened. American Society of Anesthesiologists physical status I to III individuals aged ≥14 years were included. Exclusion criteria were revision surgery, recreational drug use, opioid prescription within 2 years, and chronic pain.
PREDICTOR VARIABLE: The predictor variable was anesthetic adjunct. Subjects were randomized to receive DEX or no DEX (control).
MAIN OUTCOME VARIABLES: The primary outcome variable was 24-hour postoperative opioid consumption, which was calculated as morphine milligram equivalents (MME). Postoperative pain was assessed using a visual analog scale (VAS) at 6 hours and upon patient-controlled analgesia (PCA) discontinuation at 7:00 am the following day (VASPCA). The ratio of PCA that attempts to bolus deliveries was calculated.
COVARIATES: Covariates included age, sex, body mass index (BMI), and operative duration.
ANALYSES: Descriptive statistics were calculated. Shapiro-Wilk test was used to assess sample normality. Relationships between continuous variables and DEX were studied using t test or Wilcoxon rank-sum test; χ2 test was used for the categorical covariate. Significance was P < .05.
RESULTS: Of 66 enrollees, 50 (75.8%) subjects completed the trial (25 DEX, 25 no DEX). The mean (SD) ages for the no DEX and DEX group cohorts were 35.9 (13.5) and 41.3 (13.6), respectively (P = .2). There were no statistically significant differences in the distribution of covariates between the 2 study groups. Median (interquartile range (IQR)) morphine milligram equivalents consumption was 16.4 (15.4) and 14.8 (12.4) for no DEX and DEX groups, respectively (P = .9). No difference in pain scores was observed at 6 hours (P = .1). Median (interquartile range) VASPCA scores were 5(1) and 4(2) for no DEX and DEX cohorts, respectively (P < .01). Median ratios of PCA that attempts to boluses administered (1.23) were identical between cohorts (P = .9).
CONCLUSIONS AND RELEVANCE: The findings suggest that opioid consumption following orthognathic surgery was not associated with dexmedetomidine administration.
PURPOSE: The purpose of this study is to measure the association between dexmedetomidine (DEX) administration during orthognathic surgery and postoperative opioid consumption.
STUDY DESIGN, SAMPLE, AND SETTING: A single-blind randomized prospective cohort study was implemented. Patients consenting for orthognathic surgery at Thomas Jefferson University from January 2022 to October 2024 were screened. American Society of Anesthesiologists physical status I to III individuals aged ≥14 years were included. Exclusion criteria were revision surgery, recreational drug use, opioid prescription within 2 years, and chronic pain.
PREDICTOR VARIABLE: The predictor variable was anesthetic adjunct. Subjects were randomized to receive DEX or no DEX (control).
MAIN OUTCOME VARIABLES: The primary outcome variable was 24-hour postoperative opioid consumption, which was calculated as morphine milligram equivalents (MME). Postoperative pain was assessed using a visual analog scale (VAS) at 6 hours and upon patient-controlled analgesia (PCA) discontinuation at 7:00 am the following day (VASPCA). The ratio of PCA that attempts to bolus deliveries was calculated.
COVARIATES: Covariates included age, sex, body mass index (BMI), and operative duration.
ANALYSES: Descriptive statistics were calculated. Shapiro-Wilk test was used to assess sample normality. Relationships between continuous variables and DEX were studied using t test or Wilcoxon rank-sum test; χ2 test was used for the categorical covariate. Significance was P < .05.
RESULTS: Of 66 enrollees, 50 (75.8%) subjects completed the trial (25 DEX, 25 no DEX). The mean (SD) ages for the no DEX and DEX group cohorts were 35.9 (13.5) and 41.3 (13.6), respectively (P = .2). There were no statistically significant differences in the distribution of covariates between the 2 study groups. Median (interquartile range (IQR)) morphine milligram equivalents consumption was 16.4 (15.4) and 14.8 (12.4) for no DEX and DEX groups, respectively (P = .9). No difference in pain scores was observed at 6 hours (P = .1). Median (interquartile range) VASPCA scores were 5(1) and 4(2) for no DEX and DEX cohorts, respectively (P < .01). Median ratios of PCA that attempts to boluses administered (1.23) were identical between cohorts (P = .9).
CONCLUSIONS AND RELEVANCE: The findings suggest that opioid consumption following orthognathic surgery was not associated with dexmedetomidine administration.