Bimaxillary orthognathic surgery is one of the most complex dental and maxillofacial procedures. Such procedures are planned in the context of multispecialist treatment plans, to correct moderate to severe dentofacial deformities in young adults and, increasingly, in the clinical approach to clinical problems related to obstructive sleep apnea.
As well as a remarkably extensive dissection of the intraoral soft tissues, this type of surgery also involves detaching the periosteum and muscle fibers and mobilizing bulky bone segments. This stimulates a strong inflammatory response which results in a considerable edema and intense pain stimulation in the postoperative period.
Managing this severe pain, although expected by the patient, represents one of the most relevant issues post-surgery and systematically obliges doctors to resort to strong painkillers and/or analgesics from the opiate family. Using these types of drugs in a patient who has been administered local anesthetics and steroids as part of the procedure, however, may in turn represent a major problem.
The rationale for preventive analgesia consists in reducing intraoperative stress, and consequently postoperative pain, through pre-surgical administration of a drug or nerve block with local anesthetic.
A recent study conducted by Shetty et al. and published in the Journal of Oral and Maxillofacial Surgery set out to investigate the possibility of reducing postoperative pain in bimaxillary surgery through preventive use of regional nerve blocks. The experimenters also assessed the possible impact not only on discomfort but also on the use of analgesics, still in the postoperative stage.
The investigation was prepared according to a prospective model of a double-blind randomized clinical trial and involved a total of 110 patients, who were referred for bimaxillary surgery but not in a syndrome context. The sample was divided into two equal groups. Patients in the case group were administered bilateral, maxillary and mandibular nerve block in the lateral pterygoid via an extraoral approach. The procedure followed infiltration of the target tissues, under a general anesthesia regime, and used 5 ml of 0.25% solution of bupivacaine. This step was avoided in the control group.
The average pain scores, assessed by means of a visual-analog scale (VAS) at 6, 12, 24 and 48 hours in the postoperative period, were actually significantly lower in the test group, as were the secondary outcomes of discomfort and especially of analgesic consumption.
Although involving a small group of patients treated in a specialized manner, the study’s results are of particular interest, as they provide a perspective of improving progress – not usually simple – in these patients.