title: Effects of intravenous adenosine 5'-triphosphate on intraoperative hemodynamics and postoperative pain in patients undergoing major orofacial surgery: a double-blind placebo-controlled study.
abstract: OBJECTIVE
  We conducted a double-blind placebo-controlled study to investigate the effects of the intraoperative intravenous infusion of adenosine 5'-triphosphate (ATP) on intraoperative hemodynamics and postoperative pain in patients undergoing major orofacial surgery.
  
  
  METHODS
  Thirty patients (age, 16-42 years; 16 males/14 females) scheduled for sagittal split ramus osteotomy were assigned in a double-blind fashion to receive intraoperative intravenous infusion of ATP (n = 15) or saline (n = 15). Anesthesia was induced and maintained with propofol, fentanyl, and vecuronium. Local anesthesia was added for intraoperative analgesia. In the ATP group, ATP was infused at a rate of 160 microg.kg(-1).min(-1) throughout surgery. Postoperative pain was managed with intravenous patient-controlled analgesia (PCA) with morphine. The intensity of postoperative pain was assessed with a verbal numeric rating scale (NRS). Morphine consumption was also assessed.
  
  
  RESULTS
  There were no differences in demographic, anesthetic, and surgical data between the ATP and placebo groups. Intraoperatively, ATP effectively suppressed responses of blood pressure and heart rate to painful surgical stimuli. There were no differences in postoperative NRS scores between the two groups. However, postoperative morphine consumption was significantly less in the ATP group, compared with the placebo group, throughout the 72-h postoperative observation period. Cumulative morphine consumption for 72 h postoperatively was 47% less with ATP, compared with placebo. No adverse effect of ATP was observed.
  
  
  CONCLUSIONS
  Our data suggest that intraoperative ATP infusion can blunt hemodynamic responses to surgical stimuli and produce prolonged analgesia in patients undergoing major orofacial surgery.
authors.affiliation: Department of Dental Anesthesia and Orofacial Pain Center, Tokyo Dental College Suidoubashi Hospital, 2-9-18 Misaki-cho, Chiyoda-ku, Tokyo 101-0061, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Handa
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Fukuda
authors.forename: Masakazu
authors.initials: M
authors.lastname: Hayashida
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Koukita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ichinohe
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Kaneko
mesh_terms: D000255:Adenosine Triphosphate / Q000008:administration & dosage / Q000494:pharmacology*; D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001794:Blood Pressure; D004311:Double-Blind Method; D005145:Face / Q000601:surgery*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D009020:Morphine / Q000627:therapeutic use; D009055:Mouth / Q000601:surgery*; D010027:Osteotomy; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011229:Preanesthetic Medication; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D000255:Adenosine Triphosphate
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