The Beneficial Effect of Preoperative Dexmedetomidine in Controlling Postoperative Pain, Nausea, and Vomiting After Orthognathic Surgery: A Triple-blind Randomized Clinical Trial

Abstract

Controlling postoperative pain and nausea (PONV) following orthognathic surgery can be challenging. The aim of the study was to assess the efficacy of dexmedetomidine (DEX) in reducing pain and preventing nausea and vomiting in subjects undergoing orthognathic surgery. The authors implemented a triple-blinded, randomized clinical trial. Healthy adults with class III jaw deformity scheduled for bimaxillary orthognathic surgery were included. Subjects were randomized to the DEX or placebo groups. The DEX group received premedication with DEX 1μg/kg IV over 10minutes followed by a maintenance dose (0.2μg/kg/hour) while the placebo group received normal saline. The primary outcome variables were postoperative pain, postoperative nausea, and postoperative vomiting . Pain was assessed using a visual analog scale at 1, 3, 6, 12, 18, and 24hours, postoperatively). Nausea and vomiting were recorded throughout the postoperative period. Statistical analysis was performed using χ2, t test, and repeated measures ANOVA with a P value<.05 considered significant. A total of 60 consecutive subjects with a mean age of 24.6±3.5years completed the study. There were 38 females (63.33%) and 22 males (36.66%). The mean visual analog scale was significantly lower in the DEX group at all time-points (P<.05). There was a significantly greater demand for rescue analgesics in the placebo group compared to the DEX group (P=.01). Fourteen subjects (46.7%) in the placebo group and one subject (3.3%) in the DEX group reported nausea (P<.001). Postoperative vomiting was not observed in any of the subjects. Premedication with DEX can be considered a viable treatment option for reducing postoperative pain and postoperative nausea after bimaxillary orthognathic surgery.