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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 473-475  

Evaluation of the efficacy of regional anesthesia and intramuscular diclofenac in the management of postoperative pain: A comparative study


1 Department of Maxillofacial Surgery, Rama Dental College, Hospital and Research Center, Kanpur, Uttar Pradesh, India
2 Department of Dental Surgery, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
3 Department of Oral and Maxillofacial Surgery, Dental Department, MGM Medical College and Hospital, Jamshedpur, Jharkhand, India
4 Department of Oral Pathology, Pacific Dental College and Research Centre, Udaipur, Rajasthan, India
5 Department of Orthodontics and Dentofacial Orthopedics, ACPM Dental College, Dhule, Maharashtra, India
6 Department of Oral and Maxillofacial Surgery, Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamil Nadu, India

Date of Submission12-Oct-2020
Date of Decision14-Oct-2020
Date of Acceptance16-Oct-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Ankita Raj
Department of Oral and Maxillofacial Surgery, Rama Dental College, Hospital and Research Center, Lakhanpur, Kanpur, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_666_20

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   Abstract 


Aim: Managing postoperative pain following maxillofacial surgery is an important task. Our study aims to compare this with regional anesthesia or IM diclofenac. Materials and Methods: This study included 30 patients who underwent bi-jaw orthognathic surgery between April 2016 and January 2020. Two groups were formed. Group A was administered inferior alveolar nerve block at the surgical site bilaterally using 0.5% ropivacaine and Group B were administered 75 mg intramuscular diclofenac just before extubation. Tramadol HCl 2 mg/kg body wt is used as a rescue analgesic. The pain was evaluated periodically at 2nd, 4th, 6th, and 12 h postoperatively. Results: The mean Visual Analog Scale score was 2 in Group A and 5 in Group B. The mean duration of analgesia was 6 h 42 min, whereas in Group B, it was 8 h and 5 min. In 2 patients (13.3%) belonging to Group A and 3 patients (20%) belonging to Group B. There were no local complications in any group. Conclusion: It was observed that regional anesthesia in the form of intraoral nerve blocks was efficient than diclofenac (75 mg) administered intramuscularly for the management of immediate postoperative pain.

Keywords: Oral and maxillofacial surgery, postoperative pain, regional anesthesia


How to cite this article:
Raj A, Unnam P, Kumari R, Joshi S, Thoke B, Khanna SS. Evaluation of the efficacy of regional anesthesia and intramuscular diclofenac in the management of postoperative pain: A comparative study. J Pharm Bioall Sci 2021;13, Suppl S1:473-5

How to cite this URL:
Raj A, Unnam P, Kumari R, Joshi S, Thoke B, Khanna SS. Evaluation of the efficacy of regional anesthesia and intramuscular diclofenac in the management of postoperative pain: A comparative study. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jun 20];13, Suppl S1:473-5. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/473/317611




   Introduction Top


An oral and maxillofacial surgeon performs those surgical interventions which not only protect life but also enhance the lifestyle of an individual by augmenting their esthetics and function.[1] The oral and maxillofacial region being dynamic will invariably result in severe pain in the immediate postoperative phase following surgical interventions in this region. It is a well-known fact that the successful accomplishment of any surgical intervention depends predominantly on the effective management of postoperative pain.[2] Previous studies have also revealed the same.[3] Regional anesthesia relieves the pain without causing loss of consciousness.[4] Regional anesthesia may be employed in the form of a local infiltration of an anesthetic agent at the surgical site.[5] Previous studies have shown that in the middle of the various multimodal analgesic strategies that are available for the management of immediate postoperative pain, the use of regional anesthesia has considerably amplified.[6],[7],[8] Therefore, this study is intended to compare regional anesthesia and dcilofenac analgesic in postoperative pain.


   Materials and Methods Top


Thirty patients of 18–30 years undergoing Bim jaw orthognathic surgery were included. Informed written consent was ten. Ethical clearance was obtained form Institutional Ethical Committee. All subjects were divided in Group A and B including 15 patients each. Group A were given intraoral nerve block at the surgical site using 0.5% ropivacaine just before extubation, while Group B were administered IM diclofenac 75 mg. Drug allergy and medically compromised patients were excluded from the study. The duration of surgery and analgesia was noted. Visual Analog Scale (VAS) was used to measure pain which was evaluated on 2nd, 4th, 6th, and 12th h. In VAS > 5 IM tramadol HCl 2 mg/kg body wt was given as rescue drug. The time period at which the rescue drug was administered was recorded.


   Results Top


The mean age of 30 patients was 24.2 years. [Figure 1] elicits VAS for pain. In Group A, no patients had pain on 2nd postoperative h. On 4th h, 14 patients (93.33%) had no pain but one patient (6.7%) had pain with VAS > 5. On 6th h, 3 patients (20%) had pain with VAS > 5. The mean operating time for patients in the control group was 223.45 and the study group was 231.60 min [Figure 2]. The mean time to give rescue analgesia in Group A was 7 h and 15 min and patients in whom diclofenac was given intramuscularly, it required 6 h and 42 min for a rescue drug in patients receiving regional anesthesia in the form of intraoral nerve blocks (P = 0.001). Two (13.3%) patients in Group A and 3 patients (20%) in Group B required rescue analgesics, as shown in [Figure 3]. Complications in Group B were nausea and gastritis in 2 patients (13.3%) and 4 patients (26.6%) had pain at the injection site. However, no noticeable side effects were seen in patients receiving regional anesthesia in the form of intraoral nerve blocks. No hemodynamic changes were noticed in patients belonging to both the groups [Figure 4]. SPSS version 16 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp) was used with descriptive analysis. Chi-square test, independent sample, t-test and Mann–Whitney U-test were used for the analysis.
Figure 1: The Visual Analog Scale scores in both the groups

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Figure 2: The operating time in both the groups

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Figure 3: The need for rescue analgesic

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Figure 4: The hemodynamic changes in both the groups

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   Discussion Top


Previous studies have compared the routes of administration of analgesics and advocated that topical analgesics are useful in pain reduction.[9] Parenteral route has highest rate of action.[10] IM diclofenac or transdermal patch has good efficacy to control pain.[11],[12] Regional anesthesia in the form of nerve blocks is very beneficial in managing pain.[13] Thee major advantage of regional anesthesia is the elimination of pain both intraoperatively and postoperatively, especially with the use of a long-acting local anesthetic agent.[13] In addition to this, intraoral nerve blocks given in the immediate postoperative period reduce intraoperative bleeding by the action of the vasoconstrictors present in the local anesthetic solution.[13] Hence, this study employed the use of nerve block for the management of immediate postoperative pain. It was observed in this study that the VAS scores in Group A where the patient received nerve block in the immediate postoperative period were comparable Group B where the patients received intramuscular analgesics. The time at which a rescue analgesic was needed was also comparable between both the groups. This study used a conventional inferior alveolar nerve block (IANB) for pain management. A recent study has shown that the technique of Vazirani–Akinosi demonstrated superior outcomes in the form of lesser positive aspirations, rapid onset of action in addition to a better anesthetic attainment than the conventional IANB, and hence, it can be considered as an ideal replacement to the conventional IANB.[14] Regional anesthesia in the form of local infiltration or nerve blocks is safer compared to any route of drug administration. Routinely used drugs in the postoperative period like the NSAIDs and opioids can be avoided along with the adverse effects of these drugs like nausea, vomiting, and sedation, thereby reducing the patient's stay in the hospital. The fact that regional anesthesia is preferred over other routes of drug administration for the management of immediate postoperative pain is to reduce complications, reduce the drug dosage, and overall morbidity.[14] By administering nerve block in the postoperative period, a wide anatomical area can be devoid of pain in addition to the avoidance of needle pricks would be a great benefit, especially in pediatric patients.[12],[15] Our hemodynamic change results were in accordance with previous studies.[2],[11] Therefore, it can be advocated that a single IANB administered just prior to extubation is sufficient as an effective pain management modality.


   Conclusion Top


Regional anesthesia in the form of nerve blocks given in the immediate postoperative period eliminates pain postoperatively, especially with the use of a long-acting local anesthetic agent in addition to reduce postoperative bleeding if any by the action of the vasoconstrictors present in the local anesthetic solution. Therefore, it can be advocated that a single IANB administered just prior to extubation is sufficient to decrease the surplus analgesic need in the pain management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Vadepally AK, Sinha R, Uppada UK, Rama Krishna Reddy BV, Agarwal A. Oral and maxillofacial surgery: Perception of its scope among the medical fraternity and general public. J Cranio Max Dis 2015;4:21-7.  Back to cited text no. 1
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2.
Budharapu A, Sinha R, Uppada UK, Subramanya Kumar AV. Ropivacaine: A new local anaesthetic agent in maxillofacial surgery. Br J Oral Maxillofac Surg 2015;53:451-4.  Back to cited text no. 2
    
3.
Dobbs FF, Kumar V, Alexander JI, Hull MG. Pain after laparoscopy related to posture and ring versus clip sterilization. Br J Obstet Gynaecol 1987;94:262-6.  Back to cited text no. 3
    
4.
Bauer MC, Pogatzki-Zahn EM, Zahn PK. Regional analgesia techniques for total knee replacement. Curr Opin Anesthesiol 2014;27:501-6.  Back to cited text no. 4
    
5.
Otten C, Dunn KS. The Efficacy of Regional Anesthesia Techniques to Control Postoperative Pain After Total Knee Arthroplasty. Orthop Nurs 2018;37:177-82.  Back to cited text no. 5
    
6.
Joshi G, Gandhi K, Shah N, Gadsden J, Corman SL. Peripheral nerve blocks in the management of postoperative pain: Challenges and opportunities. J Clin Anesth 2016;35:524-9.  Back to cited text no. 6
    
7.
Shah RD, Suresh S. Applications of regional anaesthesia in paediatrics. Br J Anaesth 2013;111 Suppl 1:i114-24.  Back to cited text no. 7
    
8.
Jöhr M. Regional anaesthesia in neonates, infants and children: An educational review. Eur J Anaesthesiol 2015;32:289-97.  Back to cited text no. 8
    
9.
Predel HG, Koll R, Pabst H, Dieter R, Gallacchi G, Giannetti B, et al. Diclofenac patch for topical treatment of acute impact injuries: A randomised, double blind, placebo controlled, multicentre study. Br J Sports Med 2004;38:318-23.  Back to cited text no. 9
    
10.
Vaile JH, Davis P. Topical NSAIDs for musculoskeletal conditions. A review of the literature. Drugs 1998;56:783-99.  Back to cited text no. 10
    
11.
Perepa A, Sinha BR, Uppada UK, Kumar AS. Diclofenac Transdermal Patch: A Potential Ingress to Maxillofacial Surgery. J Maxillofac Oral Surg 2017;16:170-4.  Back to cited text no. 11
    
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Jadhav P, Sinha R, Uppada UK, Tiwari P, Subramanya Kumar AV. Pre-emptive diclofenac versus ketoprofen as a transdermal drug delivery system: How they face. J Maxillofac Oral Surg 2018;17:488-94.  Back to cited text no. 12
    
13.
Kim SM, Seo MH, Myoung H, Lee JH. Regional anesthesia for maxillofacial surgery in developing countries. J Dent Anesth Pain Med 2016;16:245-52.  Back to cited text no. 13
    
14.
Ravi Kiran BS, Kashyap VM, Uppada UK, Tiwari P, Mishra A, Sachdeva A. Comparison of Efficacy of Halstead, Vazirani Akinosi and Gow Gates Techniques for Mandibular Anesthesia. J Maxillofac Oral Surg 2018;17:570-5.  Back to cited text no. 14
    
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Kanakaraj M, Shanmugasundaram N, Chandramohan M, Kannan R, Perumal SM, Nagendran J. Regional anesthesia in faciomaxillary and oral surgery. J Pharm Bioallied Sci 2012;4:S264-9.  Back to cited text no. 15
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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