Quality of Postoperative Pain Management After Maxillofacial Fracture Repair

J Craniofac Surg. 2018 May;29(3):720-725. doi: 10.1097/SCS.0000000000004296.

Abstract

Background: Effective pain management is an essential component in the perioperative care of surgical patients. However, postoperative pain after maxillofacial fracture repair and its optimal therapy has not been described in detail.

Materials and methods: In a prospective cohort study, 95 adults rated their pain on the first postoperative day after maxillofacial fracture repair using the questionnaire of the Quality Improvement in Postoperative Pain Management (QUIPS) project. Quality Improvement in Postoperative Pain Management allowed for a standardized assessment of patients' characteristics and pain-related parameters.

Results: Overall, the mean maximal pain and pain on activity (numeric rating scales) were significantly higher in patients with mandibular fractures than in patients with midface fractures (P = 0.002 and P = 0.045, respectively). In patients with mandibular fractures, a longer duration of surgery was significantly associated with higher satisfaction with pain intensity (P = 0.015), but was more frequently associated with postoperative vomiting (P = 0.023). A shorter duration of surgery and an absence of preoperative pain counseling in these patients were significantly correlated to desire for more pain medication (P = 0.049 and P = 0.004, respectively). Patients with mandibular fractures that received opioids in the recovery room had significantly higher strain-related pain (P = 0.017). In patients with midface fractures, a longer duration of surgery showed significantly higher levels of decreased mobility (P = 0.003). Patients receiving midazolam for premedication had significantly less minimal pain (P = 0.021).

Conclusions: Patients with mandibular fractures seem to have more postoperative pain than patients with midface fractures. Monitoring of postsurgical pain and a procedure-specific pain-treatment protocol should be performed in clinical routine.

MeSH terms

  • Adult
  • Facial Bones* / injuries
  • Facial Bones* / surgery
  • Humans
  • Maxilla* / injuries
  • Maxilla* / surgery
  • Maxillary Fractures / surgery*
  • Pain Management* / methods
  • Pain Management* / standards
  • Pain Management* / statistics & numerical data
  • Pain Measurement
  • Pain, Postoperative / epidemiology
  • Pain, Postoperative / therapy*
  • Prospective Studies
  • Quality Improvement