title: Bilateral sagittal split osteotomy-parameters and correlations of postoperative pain management.
abstract: OBJECTIVE
  Postoperative pain management is of utmost interest for patients undergoing orthognathic surgery. Currently, there is a lack of information regarding process and outcome parameters of postoperative pain management after bilateral sagittal split osteotomy.
  
  
  METHODS
  In a prospective clinical study, 31 adults were evaluated on the first postoperative day following bilateral sagittal split osteotomy using the standardized questionnaire of the Germany-wide project Quality Improvement in Postoperative Pain Management (QUIPS). It allows a standardized assessment of patients' characteristics, pain parameters, outcome, and pain therapy process parameters.
  
  
  RESULTS
  Pain management consisted mainly of premedication with midazolam, sufentanil, and metamizol intraoperatively; piritramide in the recovery room; and metamizol and tramadol on ward. Twenty patients (64.5%) showed inadequate pain management with pain levels ≥4. Patients receiving tramadol as opioid on ward presented significantly higher maximum pain levels (p = .037). Significantly lower satisfaction with postoperative pain intensity (p > .001) and significantly higher desire for additional pain medication (p = .023) were detected, when duration of surgery was above the median of 107.5 min.
  
  
  CONCLUSIONS
  Inadequate pain management on the first postoperative day following bilateral sagittal split osteotomy was widespread on our ward. QUIPS helped us to identify it and thereby gave us the possibility to improve the situation. Prolonged duration of surgery seems to be a predictor of an elevated postoperative pain medication demand.
  
  
  CONCLUSIONS
  Only the establishment of an ongoing monitoring of postoperative pain management can help to reduce or even avoid inadequate postoperative pain management. In accordance to the existing literature, we found inadequate postoperative pain management more widespread than thought.
authors.affiliation: Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany. raschke.gregor@googlemail.com.
authors.forename: Gregor F
authors.initials: GF
authors.lastname: Raschke
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Winfried
authors.initials: W
authors.lastname: Meissner
authors.affiliation: Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Andre
authors.initials: A
authors.lastname: Peisker
authors.affiliation: Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany.|Department of Plastic, Reconstructive and Aesthetic Surgery, Innsbruck Medical University, Anichstraße 35, 6020, Innsbruck, Austria.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Djedovic
authors.affiliation: Department of Plastic & Aesthetic, Reconstructive and Hand Surgery, St. Markus Hospital, Johann Wolfgang von Goethe University, Frankfurt/Main, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rieger
authors.affiliation: Marquette University School of Dentistry, Milwaukee, WI, USA.
authors.forename: Arndt
authors.initials: A
authors.lastname: Guentsch
authors.affiliation: Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Marta Gomez
authors.initials: MG
authors.lastname: Dammeier
authors.affiliation: Department of Cranio-Maxillofacial & Plastic Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schultze-Mosgau
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008312:Malocclusion, Angle Class II / Q000601:surgery*; D008313:Malocclusion, Angle Class III / Q000601:surgery*; D059229:Osteotomy, Sagittal Split Ramus; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D011292:Premedication; D011446:Prospective Studies
chemical_list: D000700:Analgesics
keywords: Bilateral sagittal split osteotomy; Orthognathic surgery; Postoperative pain