The effect of local injection of bupivacaine with and without fentanyl at the operative site in mandibular open reduction on acute pain intensity and opioid requirement: a randomized clinical trial.

PURPOSE: The aim of this study is to investigate the effects of bupivacaine local injection with and without fentanyl at the operative site in mandibular open reduction surgeries on the severity of acute pain and the need for opioids. METHODS: This randomized clinical trial, age-sex-matched double-blind study included 44 patients with isolated mandibular fractures who would be candidates for open reduction. They were divided into two groups (intervention using fentanyl and control not using fentanyl). In both groups, the amount of opioid used, hemodynamic indices, oxygen saturation, and pain intensity were collected based on the Visual Analogue Scale (VAS) every 4 h for 24 h. RESULTS: As for basic and demographic variables such as gender, age, ASA class, and duration of surgery (P > 0.05), there was neither a significant difference between the two groups nor was there any difference in nausea and vomiting and subsequent anti-nausea medication (P > 0.05). The need for a post-operative opioid in the bupivacaine + fentanyl group (13.6%) was significantly less than in those who received only bupivacaine (45.5%) (P < 0.05). Changes in pain scores over time were significantly different in the two groups, and bupivacaine + fentanyl reduced pain more than bupivacaine (P < 0.05). However, over time, there was no significant difference between the two groups in terms of changes in oxygen saturation, heart rate, systolic blood pressure, and diastolic blood pressure (P > 0.05). CONCLUSION: The addition of fentanyl to bupivacaine for supraperiosteal injection in the open reduction surgery site reduces post-operative pain in the first 24 h and reduces the need for opioids without causing complications such as nausea and vomiting.

Opioid requirement and pain intensity after mandibular surgeries with dexmedetomidine administration in two ways: intraoperative infusion versus bolus injection.

PURPOSE: The purpose of this study is to compare the opioid requirement and pain intensity after surgeries of mandibular fractures with administration of dexmedetomidine by two approaches of infusion and single bolus. METHODS: In this double-blind clinical trial, the participants were randomized and matched in terms of age and gender in two groups (infusion and bolus). In both groups, the amount of narcotic used, hemodynamic indices, oxygen saturation, and pain intensity were collected based on the ten-point Visual Analogue Scale (VAS) at 7 time points for 24 h. SPSS version 24 software was used for data analysis. A significance level of less than 5% was considered. RESULTS: A total of 40 patients were included in the study. There was no significant difference between the two groups in terms of gender, age, ASA class, and duration of surgery (P>0.05). There was no significant difference between the two groups in terms of nausea and vomiting and subsequently receiving anti-nausea medication (P>0.05). The need for opioid consumption after surgery was not different in two groups (P>0.05). Infusion of dexmedetomidine reduced postoperative pain more rapidly than its single bolus dose (P<0.05). However, over time, there was no significant difference between the two groups in terms of changes in oxygen saturation variables (P>0.05). Homodynamic indices including heart rate, systolic blood pressure, and diastolic blood pressure in the bolus group were significantly lower than the infusion group (P<0.05). CONCLUSION: Administration of dexmedetomidine in the form of infusion can reduce postoperative pain better than bolus injection, with less probability of hypotension and bradycardia.

[Calcitonin as an analgesic agent: review of mechanisms of action and clinical applications]. / Calcitonina como agente analgésico: revisão dos mecanismos de ação e das aplicações clínicas.

BACKGROUND AND OBJECTIVES: Calcitonin is a polypeptide hormone regulating the metabolism calcium in the body. For many years calcitonin has been used to maintain and improve bone mineral density and to reduce the fracture rate. Many studies showed that calcitonin had analgesic role in several painful circumstances. This pain-ameliorating effect is irrelevant to its osteoclastic inhibitory effect and mechanisms like altering Na+ channel and serotonin receptor expression or hypothesis including the endorphin-mediated mechanism were used to explain this effect. In this study we performed a thorough review on the role of calcitonin as an analgesic agent in different scenarios and investigated the fact that calcitonin can be a feasible medication to relieve pain. METHOD: Many studies focused on the analgesic effect of calcitonin in several painful circumstances, including acute pains related to vertebral fractures, metastasis, migraine and reflex sympathetic dystrophy as well as neuropathic pains related to spinal injuries or diabetes, and phantom pain. Also, calcitonin was showed to be a useful additive to local anesthesia in the case of controlling postoperative pain or trigeminal neuralgia more effectively. However we faced some contradictory data for conditions like lumbar canal stenosis, complex regional pain syndrome, phantom pain and malignancies. CONCLUSION: This study showed that calcitonin could be helpful analgesic agent in different painful situations. Calcitonin can be considered an eligible treatment for acute pains related to vertebral fractures and a feasible alternative for the treatment of the acute and chronic neuropathic pains where other medications might fail.

Comparison of Pain Relief from Different Intravenous Doses of Ketorolac after Reduction of Mandibular Fractures.

INTRODUCTION: Pain is an unpleasant feeling due to tissue destruction, which disturbs an individual's daily routines even at its lowest levels. The majority of surgeons and anaesthesiologists are increasingly trying to administer non-opioid analgesics because excessive use of opioids after surgery results in patient dissatisfaction. AIM: To evaluate the analgesic effect of intravenous injection of different doses of ketorolac at different intervals in patients undergoing surgery for unilateral fractures of the mandible. MATERIALS AND METHODS: In the present randomized clinical trial (March 2016 to January 2017, in Tabriz Imam Reza Treatment/Educational Center), 50 patients were assigned to five groups with simple randomization method. In Group 1 and 2, immediately before the induction of general anaesthesia 30 and 60 mg of ketorolac and in Group 3 and 4, immediately before termination of surgery 30 and 60 mg of ketorolac was injected intravenously. In Group 5, ketorolac was not administered. After each patient regained complete consciousness, the severity of pain was determined using VAS up to 24 hours at baseline and at 2, 4, 6, 12 and 24-hours intervals. The total dose of the opioid analgesic agent (morphine-pethidine) and the time for the first request for an analgesic agent were recorded for each patient and their means were compared in each group with suitable statistical tests. RESULTS: The patients in Group 5 and 4 exhibited the highest and lowest mean pain scores (5.03±0.9 and 3.5±1), respectively. ANOVA for repeated measures and post-hoc Tukey tests showed significant differences only between Group 3 and 5 (p=0.002) and Group 4 and 5 (p=0.001), with no significant differences between the other groups (p>0.005). The highest dose of the analgesic agent was in Group 5 (5.3±1.4 mg) and the lowest dose was recorded in Group 4 (1.6±0.6 mg). Patients in the control group received significantly higher doses compared to the other groups (p<0.05). The patients in Group 1 and 2 received higher doses of analgesics compared to Group 3 and 4 (p<0.05). The longest time for the request for the first dose of analgesic agent after surgery was 73.4±12.03 minutes in Group 4 The patients in the control group had requested analgesics after surgery at a significantly shorter time compared to the patients in all the study groups (p<0.05). The patients in Group 1 and 2 had requested analgesics at a shorter time after surgery compared to the subjects in Group 3 and 4 (p<0.05). CONCLUSION: Intravenous administration of 30 and 60 mg of ketorolac, immediately before termination of surgery, decreases the pain severity and the need for opioid analgesics after surgery.