Preoperative diclofenac sodium and tramadol for pain relief after bimaxillary osteotomy.
OBJECTIVE
The aim of this study was to compare the postoperative analgesic affects of preoperative use of a synthetic opioid tramadol and a nonsteroidal anti-inflammatory drug diclofenac sodium for postoperative pain, with placebo, in patients undergoing bimaxillary osteotomy.


METHODS
Thirty-six orthognathic surgery patients who underwent both Le Fort I osteotomy in the maxilla and bilateral sagittal split ramus osteotomy in the mandible as bimaxillary osteotomy were randomly allocated into 3 groups via sealed envelope technique. Group T (n = 12), group D (n = 12), and group P (n = 12) received preoperative 50 mg tramadol intramuscularly, 75 mg diclofenac sodium intramuscularly, and saline, respectively. Postoperative pain intensity (visual analog scale, verbal pain score), postoperative opioid consumption with intravenous patient-controlled analgesia, hemodynamic variables, and postoperative complications were compared among the 3 groups.


RESULTS
The median number of patient-controlled analgesia demands (n) in group P (34, 28-39) was higher than other groups (group D 14, 11-13; group T 19, 12-25; P = .001). Total tramadol consumption was higher in group P (330 mg, 290-390) compared with group D (260 mg, 190-340; P = .046) and group T (270 mg, 200-330; P = .034). The 3 groups were comparable for the area under the hemodynamic variables time curves. The area under the visual analog scale and verbal pain score curves were lower in group D and group T compared with group P, however, there was no significant difference between group T and group D.


CONCLUSIONS
Preoperative diclofenac or tramadol, compared with placebo, effectively decreases postoperative opioid consumption via intravenous patient-controlled analgesia.
Tuzuner
Aysegul Mine
AM
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey.
Ucok
Cahit
C
Kucukyavuz
Zuhal
Z
Alkis
Neslihan
N
Alanoglu
Zekeriyya
Z
D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods / Q000523:psychology; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D004008:Diclofenac / Q000008:administration & dosage* / Q000009:adverse effects; D004338:Drug Combinations; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000601:surgery; D008437:Maxilla / Q000601:surgery; D008614:Meperidine / Q000009:adverse effects / Q000627:therapeutic use; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011300:Preoperative Care / Q000379:methods; D013997:Time Factors; D014147:Tramadol / Q000008:administration & dosage* / Q000009:adverse effects
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004338:Drug Combinations; D004008:Diclofenac; D014147:Tramadol; D008614:Meperidine