Dexmedetomidine Decreases Postoperative Pain and Narcotic Use in Children Undergoing Alveolar Bone Graft Surgery

Lopez, Mariela; Zech, Derrick; Linton, Judith; Blackwell, Steven J.

doi:10.1177/1055665618754949

Cited by 12 publications

(5 citation statements)

References 22 publications

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“…These studies demonstrated a decrease in postoperative opioid medication requirements while also decreasing postoperative nausea and vomiting. Dexmedetomidine has been studied in the management of patients following head and neck surgery . Decreased opioid usage has been reported in children undergoing tonsillectomy and alveolar bone graft when dexmedetomidine is included in the perioperative regimen.…”

Section: Resultsmentioning

confidence: 99%

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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IMPORTANCEOpioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.

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Section: Resultsmentioning

confidence: 99%

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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“…Other studies have examined the effect of intraoperative anesthetics, demonstrating the intraoperative use of dexmedetomidine and ketamine reduced the need for postoperative opioids [7]. Finally, when performing alveolar bone grafting, managing donor site pain has been explored in a variety of ways [8–11]. There has been recent research into expanding the use of, and the indications for, peripheral nerve blockade in oral and head and neck procedures including palatoplasty in the aftermath of the opioid epidemic in North America and elsewhere [12,13,14 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative pain management in pediatric cleft lip and palate repair

Flowers

Winters

2021

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review There has been an increased interest in the literature on methods to improve perioperative outcomes in surgical patients while minimizing opioid use. Pediatric cleft palate repair can be a painful procedure, and this postoperative pain can lead to longer hospital stays and worse surgical outcomes. Recent findings Recent literature has explored four key areas surrounding analgesia after cleft lip and palate repair. These areas are management of postoperative pain with nonopioid oral analgesics, peripheral nerve blockade, liposomal bupivacaine for donor-site analgesia in bone grafting, and enhanced recovery after surgery (ERAS) protocols. Summary The included studies indicate that patients undergoing palatoplasty may have a decreased opioid requirement if nonopioid analgesics such as acetaminophen and ibuprofen are started early in the postoperative setting. Peripheral nerve blockade is an important adjunct to analgesia in these patients. Suprazygomatic maxillary nerve blockade may improve pain management over traditional infraorbital nerve blockade. In patients undergoing alveolar bone grafting, injection of liposomal bupivacaine into the donor site can significantly decrease oral opioid requirements. Finally, ERAS protocols are emerging ways to decrease postoperative pain in cleft palate patients.

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“…Recent studies have investigated various perioperative and postoperative interventions that decrease opioid use. [5][6][7] However, current literature is conflicted when discussing the use of perioperative acetaminophen to decrease postoperative narcotic use. This study's purpose was to answer the following clinical question: 'Among patients who are undergoing orthognathic surgery, do patients receiving perioperative or acetaminophen have decreased inpatient opioid use compared to those who do not?'…”

mentioning

confidence: 99%

“…Limited range of motion of the mouth after orthognathic surgery adds a layer of complexity to pain management given increased difficulty for oral pain management and increased overall discomfort from liquid only diets. Recent studies have investigated various perioperative and postoperative interventions that decrease opioid use 5–7 . However, current literature is conflicted when discussing the use of perioperative acetaminophen to decrease postoperative narcotic use.…”

mentioning

confidence: 99%

Decreasing Inpatient Opioid Use Following Orthognathic Surgery

Phillips

Peck

Pourtaheri

et al. 2021

Journal of Craniofacial Surgery

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Strategies to decrease postoperative opioid use are important for mitigating the immediate and long-term risks associated with their use. We aimed to investigate the impact of perioperative various factors on inpatient opioid needs for patients undergoing orthognathic surgery. Methods: This was a retrospective cohort study of all patients who underwent orthognathic surgery performed by the senior author from 2012 to 2018. Patients were grouped into intravenous (IV) acetaminophen and no-IV acetaminophen cohorts. Opioid medications received by patients during hospital stay were converted to mean morphine equivalents (MME) for comparison. Additional factors that influenced opioid consumption, such as transexamic acid (TXA) and postoperative nausea and vomiting (PONV), were identified using univariate analysis. Factors found to have statistical significance were added to a multivariate linear regression model. Results: 319 patients were included. Those who received IV acetaminophen had lower rates of total opioid use (57.3 versus 74.8 MME; P ¼ 0.002) and postoperative opioid use (24.0 versus 37.7 MME; P < 0.001). Perioperative prothrombotic agents, such as TXA, were associated with lower total and postoperative MME (P ¼ 0.005, P ¼ 0.002). Multivariate regression analysis showed that increased PONV resulted in increased postoperative opioid use, whereas perioperative acetaminophen lowered total and postoperative quantities. Conclusions: Perioperative IV acetaminophen is an effective method for decreasing inpatient opioid analgesia after orthognathic surgery. Intravenous TXA and PONV control may provide additional benefit to decreasing inpatient opioid consumption. More research as to the mechanisms and ideal clinical applications for both IV acetaminophen and TXA are warranted.

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Dexmedetomidine Decreases Postoperative Pain and Narcotic Use in Children Undergoing Alveolar Bone Graft Surgery

Cited by 12 publications

References 22 publications

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

Postoperative pain management in pediatric cleft lip and palate repair

Decreasing Inpatient Opioid Use Following Orthognathic Surgery

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