title: Factors that affect intravenous patient-controlled analgesia for postoperative pain following orthognathic surgery for mandibular prognathism.
abstract: The predictors of postoperative pain and analgesic consumption were previously found to include preoperative pain, anxiety, age, type of surgery, and genotype, but remaining unclear was whether intraoperative factors could predict postoperative pain. In the present study, we investigated the time-course of fentanyl consumption using intravenous patient-controlled analgesia records from patients who underwent orthognathic surgery for mandibular prognathism and analyzed the influence of anesthesia methods and surgical methods together with sex on the time course. A significant difference in the time course of fentanyl administration was found (P<0.001). No significant difference in the time course of fentanyl administration was found between males and females (P = 0.653), with no interaction between time course and sex (P = 0.567). No significant difference in the time course of fentanyl administration was found among anesthesia methods, such as fentanyl induction followed by fentanyl maintenance, fentanyl induction followed by remifentanil maintenance, and remifentanil induction followed by remifentanil maintenance (P = 0.512), but an interaction between time course and anesthesia method was observed (P = 0.004). A significant difference in the time course of fentanyl administration was found between surgical methods, such as bilateral mandibular sagittal split ramus osteotomy (BSSRO) and BSSRO combined with Le Fort I osteotomy (bimaxillary; P = 0.008), with no interaction between time course and surgical method (P = 0.535). Total postoperative 24 h consumption associated with the bimaxillary procedure was significantly higher than with BSSRO (P = 0.008). The present results indicate that administration patterns and total 24 h consumption were different among the three groups of anesthesia methods and between the two groups of surgical methods, respectively. Although more research on patient-controlled analgesia patterns and consumption is necessary, the present study will contribute to adequately relieving individual patients from postoperative pain.
authors.affiliation: Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Aoki
authors.affiliation: Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nishizawa
authors.affiliation: Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kasai
authors.affiliation: Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ichinohe
authors.affiliation: Addictive Substance Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Dental Anesthesiology, Tokyo Dental College, Tokyo, Japan.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D057909:Orthognathic Surgery / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D005283:Fentanyl