No abstract

Management of secondary chronic osteomyelitis (SCO) of the mandible is complex and challenging condition. Antibiotics are often first line treatment but have difficulty penetrating the infected bone and surgical intervention can be extensive, disfiguring and may not provide cure. With increasing reports of successful management of primary chronic osteomyelitis with bisphosphonate therapy, it was considered a viable last line trial medication in a refractory SCO patient for whom surgery was not appropriate. The current case is the first in the literature to report successful management of SCO with oral bisphosphonates.

Introduction:We describe the adjunctive use of local anaesthesia during surgical removal of lower third molars under general anaesthesia to manage postoperative pain. Our limited study shows that it is beneficial to administer a long-acting local anaesthetic such as bupivacaine with adrenaline for prolonged pain control.Method: Eleven patients, requiring lower third molar extractions under general anaesthetic were included in this study. Parameters recorded were type, volume and concentration of local anaesthetic used +/-adrenaline as well as intraoperative analgesia prescribed by anaesthetist. All patients were administered bupivacaine by infiltration to the buccal and lingual vestibules in the anaesthetic preparation room immediately after induction and intubation. A pain questionnaire was filled by the patients a few days after their procedure. Results:The overall low pain scores was low. A mean duration of postoperative anaesthesia was 9.4 hours. The average time to first rescue analgesic medication was 8.9 hours. The mean postoperative pain score was 3 after waking up from general anaesthesia and 5 after the anaesthetic effects of bupivacaine had worn off. Three patients did not require postoperative analgesic medication. Conclusion:Bupivacaine with adrenaline provides excellent prolonged postoperative pain control and analgesia following surgical removal of lower third molars for up to twelve hours. The duration of anaesthetic effect is prolonged by the addition of epinephrine 1:200,000 [1]. Hence, the time to rescue analgesic medication is much longer and the need for analgesia is reduced [1,2]

Introduction:We describe the adjunctive use of local anaesthesia during surgical removal of lower third molars under general anaesthesia to manage postoperative pain. Our limited study shows that it is beneficial to administer a long-acting local anaesthetic such as bupivacaine with adrenaline for prolonged pain control.Method: Eleven patients, requiring lower third molar extractions under general anaesthetic were included in this study. Parameters recorded were type, volume and concentration of local anaesthetic used +/-adrenaline as well as intraoperative analgesia prescribed by anaesthetist. All patients were administered bupivacaine by infiltration to the buccal and lingual vestibules in the anaesthetic preparation room immediately after induction and intubation. A pain questionnaire was filled by the patients a few days after their procedure. Results:The overall low pain scores was low. A mean duration of postoperative anaesthesia was 9.4 hours. The average time to first rescue analgesic medication was 8.9 hours. The mean postoperative pain score was 3 after waking up from general anaesthesia and 5 after the anaesthetic effects of bupivacaine had worn off. Three patients did not require postoperative analgesic medication. Conclusion:Bupivacaine with adrenaline provides excellent prolonged postoperative pain control and analgesia following surgical removal of lower third molars for up to twelve hours. The duration of anaesthetic effect is prolonged by the addition of epinephrine 1:200,000 [1]. Hence, the time to rescue analgesic medication is much longer and the need for analgesia is reduced [1,2]

Introduction:We describe the adjunctive use of local anaesthesia during surgical removal of lower third molars under general anaesthesia to manage postoperative pain. Our limited study shows that it is beneficial to administer a long-acting local anaesthetic such as bupivacaine with adrenaline for prolonged pain control.Method: Eleven patients, requiring lower third molar extractions under general anaesthetic were included in this study. Parameters recorded were type, volume and concentration of local anaesthetic used +/-adrenaline as well as intraoperative analgesia prescribed by anaesthetist. All patients were administered bupivacaine by infiltration to the buccal and lingual vestibules in the anaesthetic preparation room immediately after induction and intubation. A pain questionnaire was filled by the patients a few days after their procedure. Results:The overall low pain scores was low. A mean duration of postoperative anaesthesia was 9.4 hours. The average time to first rescue analgesic medication was 8.9 hours. The mean postoperative pain score was 3 after waking up from general anaesthesia and 5 after the anaesthetic effects of bupivacaine had worn off. Three patients did not require postoperative analgesic medication. Conclusion:Bupivacaine with adrenaline provides excellent prolonged postoperative pain control and analgesia following surgical removal of lower third molars for up to twelve hours. The duration of anaesthetic effect is prolonged by the addition of epinephrine 1:200,000 [1]. Hence, the time to rescue analgesic medication is much longer and the need for analgesia is reduced [1,2]