Patients who undergo mandibular fracture experience a significant amount of pain following surgery, but little data are available on how to manage that pain.
“This suggests that there are few guidelines for optimal pain management strategies for mandible fracture patients,” said Sydney C. Butts, MD, chief of facial plastic and reconstructive surgery in the department of otolaryngology at State University of New York Downstate Medical Center in Brooklyn.
This was the finding of a systematic review of the literature that Dr. Butts and his colleagues undertook to examine pain management protocols reported in randomized clinical trials of mandibular fractures between 1970 and July 2014 (JAMA Facial Plast Surg. September 3, 2015; doi: doi:10.1001/jamafacial.2015.1011).
Among the 38 studies included in the review, only five (13%) reported the analgesic medication prescribed to patients in the study. Of these five studies, three (60%) documented the use of nonsteroidal anti-inflammatory drugs (NSAIDs) combined with acetaminophen, and two (40%) documented the use of acetaminophen alone.
None of the studies looked specifically at postoperative pain management as the primary outcome. According to Dr. Butts, this is in contrast to the multiple studies that have looked at the management of post-operative pain in other types of upper and lower jaw surgery.
While opioids may be the first-line medication used for post-operative pain for U.S. surgeons, Dr. Butts said that the potential negative side effects such as respiratory depression, nausea, vomiting, and urinary retention may be more dangerous for patients suffering from facial trauma. As such, other options are needed such as the use of NSAIDs, which have been found in other facial trauma surgery studies to control pain, decrease the need for opioids, and avoid negative side effects (JAMA Facial Plast Surg. 2014;16:306-309).
Based on these results, Dr. Butts emphasized that “dedicated research on the best analgesic agents (or combination of them) is warranted.”