Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use
Abstract
:Introduction
Risk Factors for Opioid Use
Pediatric Opioid Use
Limiting Opioid Use
Other Medications and Multimodal Therapy
Non-Steroidal Anti-Inflammatory Drugs
Multimodal Therapy
Nonpharmacologic Therapies
Conclusion
Funding
Institutional Review Board Statement
Conflicts of Interest
References
- Schiller, E.; Goyal, A.; Mechanic, O. Opioid Overdose; StatPearls Publishing: Treasure Island, FL, USA, 2022. Available online: https://www.ncbi.nlm.nih.gov/books/NBK470415/ (accessed on 2 July 2022).
- Dowell, D.; Haegerich, T.M.; Chou, R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States. Recommendations and Reports. 2016. Available online: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm (accessed on 3 July 2022).
- Seth, P.; Scholl, L.; Rudd, R.A.; Bacon, S. Overdose deaths involving opioids, cocaine, and psychostimulants—United States, 2015–2016. MMWR Morb Mortal Wkly Rep. 2018, 67, 349–358. [Google Scholar] [CrossRef]
- Curtis, C.; Scarcella, J.; Viscardi, C.; Samia, A.; Zeri, R.; Guo, Y. Reduction of opioid prescriptions in maxillofacial trauma following North Carolina STOP Act. Craniomaxillofac Trauma Reconstr. 2021, 14, 231–235. [Google Scholar] [CrossRef]
- DEA. The Controlled Substances Act. 25 July 2018. Available online: https://www.dea.gov/drug-information/csa (accessed on 2 July 2022).
- Fortune, S.; Frawley, J. Optimizing pain control and minimizing opioid use in trauma patients. AACN Adv Crit Care 2021, 32, 89–104. [Google Scholar] [CrossRef]
- Drahos, A.L.; Scott, A.M.; Johns, T.J.; Ashley, D.W. Multimodal analgesia and decreased opioid use in adult trauma patients. Am Surg. 2020, 86, 950–954. [Google Scholar] [CrossRef]
- Chaudhary, M.A.; Schoenfeld, A.J.; Harlow, A.F.; et al. Incidence and predictors of opioid prescription at discharge after traumatic injury. JAMA Surg. 2017, 152, 930. [Google Scholar] [CrossRef]
- DiMaggio, C.J.; Avraham, J.B.; Lee, D.C.; Frangos, S.G.; Wall, S.P. The epidemiology of emergency department trauma discharges in the United States. Acad Emerg Med. 2017, 24, 1244–1256. [Google Scholar] [CrossRef]
- Lapidus, J.B.; Santosa, K.B.; Skolnick, G.B.; et al. Opioid prescribing and use patterns in postsurgical facial trauma patients. Plast Reconstr Surg. 2020, 145, 780–789. [Google Scholar] [CrossRef]
- Barbarite, E.; Occhiogrosso, J.; McCarty, J.C.; et al. Opioid prescribing patterns among facial plastic and reconstructive surgeons in the medicare population. Facial Plast Surg Aesthet Med. 2021, 23, 401–404. [Google Scholar] [CrossRef]
- Shah, J.; Lesko, R.P.; Lala, B.; Ricci, J. Trends in opioid prescription for craniomaxillofacial trauma in the United States: An 11-year retrospective study of emergency room and office visits. Surgery. 2021, 170, 232–238. [Google Scholar] [CrossRef] [PubMed]
- Sagheer, S.H.; Yan, B.M.; Bovenzi, C.D.; et al. Postoperative opioid-prescribing practices in nasal surgery: A prospective study. Facial Plast Surg Aesthet Med. 2022, 24, 266–270. [Google Scholar] [CrossRef]
- Morgan, A.C.; Davis, G.L.; Mehta, I.H.; Stark, P.; Paap, M.K.; Gosman, A.A. Analysis of narcotic use in isolated facial fractures: Potential targets for a narcotic reduction protocol. J Craniofac Surg. 2021, 32, 1033–1036. [Google Scholar] [CrossRef]
- Bell, T.M.; Raymond, J.; Vetor, A.; et al. Long-term prescription opioid utilization, substance use disorders, and opioid overdoses after adolescent trauma. J Trauma Acute Care Surg. 2019, 87, 836–840. [Google Scholar] [CrossRef]
- Foster, A.A.; Porter, J.J.; Bourgeois, F.T.; Mannix, R. The use of opioids in low acuity pediatric trauma patients. PLoS ONE 2019, 14, e0226433. [Google Scholar] [CrossRef]
- Som, A.; Santosa, K.B.; Skolnick, G.B.; Lapidus, J.B.; Waljee, J.F.; Patel, K.B. Opioid use among adolescents undergoing surgical repair of facial trauma. Plast Reconstr Surg. 2021, 147, 690–698. [Google Scholar] [CrossRef]
- Tatch, W. Opioid prescribing can be reduced in oral and maxillofacial surgery practice. J Oral Maxillofac Surg. 2019, 77, 1771–1775. [Google Scholar] [CrossRef]
- Fortune, S.; Frawley, J. Optimizing pain control and minimizing opioid use in trauma patients. AACN Adv Crit Care. 2021, 32, 89–104. [Google Scholar] [CrossRef]
- Haines, K.L.; Fuller, M.; Antonescu, I.; et al. Underutilization of acetaminophen in older adult trauma patients. Am Surg 2022, 88, 2003–2010. [Google Scholar] [CrossRef]
- Merry, A.F.; Gibbs, R.D.; Edwards, J.; et al. Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: A randomized controlled trial. Br J Anaesth. 2010, 104, 80–88. [Google Scholar] [CrossRef]
- Michigan Pain Control Optimization Pathway (MPOP). Managing Your Pain after Surgery Without Opioids; University of Michigan: Ann Arbor MI, USA, 2020; Available online: https://www.med.umich.edu/1libr/Surgery/MPOPeducation-ManagingPainWithoutOpioids.pdf (accessed on 12 August 2022).
- Dunn, L.K.; Durieux, M.E. Perioperative use of intravenous lidocaine. Anesthesiology 2017, 126, 729–737. [Google Scholar] [CrossRef]
- Zhu, J.; Liu, J.; Shen, G.; Zhong, T.; Yu, X. Comparison of efficacy outcomes of lidocaine spray, topical lidocaine injection, and lidocaine general anesthesia in nasal bone fractures surgeries: A randomized, controlled trial. Med Sci Mon Int Med J Exp Clin Res. 2018, 24, 4386–4394. [Google Scholar] [CrossRef]
- Jeong, Y.J.; Kim, H.J.; Kwon, H.; Shim, H.S.; Seo, B.F.; Jung, S.N. The use of topical lidocaine gel during intermaxillary fixation procedure. J Craniofac Surg. 2016, 27, e475–e477. [Google Scholar] [CrossRef]
- Velioglu, O.; Calis, A.S.; Koca, H.; Velioglu, E. Bupivacaine vs. lidocaine: A comparison of local anesthetic efficacy in impacted third molar surgery. Clin Oral Investig. 2020, 24, 3539–3546. [Google Scholar] [CrossRef]
- Yu, X.; Wang, J.; Huang, L.; Yu, X.; He, Z. Efficacy and safety of bupivacaine versus lidocaine in local anesthesia of the nasopharynx: A meta-analysis. Am J Rhinol Allergy. 2016, 30, e176–e180. [Google Scholar] [CrossRef]
- Neal, T.W.; Hammad, Y.; Schlieve, T. Liposomal bupivacaine: A literature review of applications in oral and maxillofacial surgery. J Oral Maxillofac Anesth. 2022, 1, 3. [Google Scholar] [CrossRef]
- Wallen, T.E.; Singer, K.E.; Makley, A.T.; et al. Intercostal liposomal bupivacaine injection for rib fractures: A prospective randomized controlled trial. J Trauma Acute Care Surg. 2022, 92, 266–276. [Google Scholar] [CrossRef]
- Ott, M. Efficacy of liposomal bupivacaine in orthopedic procedures in an academic trauma hospital. Ann Musculoskelet Med. 2017, 1, 027–031. [Google Scholar] [CrossRef]
- Davidovitch, R.; Goch, A.; Driesman, A.; Konda, S.; Pean, C.; Egol, K. The use of liposomal bupivacaine administered with standard bupivacaine in ankle fractures requiring open reduction internal fixation: A single-blinded randomized controlled trial. J Orthop Trauma. 2017, 31, 434–439. [Google Scholar] [CrossRef]
- Hubler, C.P.; Bevil, K.M.; Greiner, J.J.; Hetzel, S.J.; Borden, S.B.; Cios, H.A. Liposomal bupivacaine versus standard bupivacaine in the adductor canal for total knee arthroplasty: A randomized, controlled trial. Orthopedics. 2021, 44, 249–255. [Google Scholar] [CrossRef]
- Ma, T.T.; Wang, Y.H.; Jiang, Y.F.; et al. Liposomal bupivacaine versus traditional bupivacaine for pain control after total hip arthroplasty. Medicine 2017, 96, e7190. [Google Scholar] [CrossRef]
- Alter, T.H.; Liss, F.E.; Ilyas, A.M. A prospective randomized study comparing bupivacaine hydrochloride versus bupivacaine liposome for pain management after distal radius fracture repair surgery. J Hand Surg Am. 2017, 42, 1003–1008. [Google Scholar] [CrossRef]
- Folino, T.; Mahboobi, S. Regional Anesthetic Blocks; StatPearls Publishing: Treasure Island, FL, USA, 2021. [Google Scholar]
- Wong, S.S.; Chan, W.S.; Fang, C.; et al. Infraclavicular nerve block reduces postoperative pain after distal radial fracture fixation: A randomized controlled trial. BMC Anesthesiol. 2020, 20, 130. [Google Scholar] [CrossRef]
- Joshi, G.; Gandhi, K.; Shah, N.; Gadsden, J.; Corman, S.L. Peripheral nerve blocks in the management of postoperative pain: Challenges and opportunities. J Clin Anesth. 2016, 35, 524–529. [Google Scholar] [CrossRef]
- Bertuit, M.; Rapido, F.; Ly, H.; et al. Bilateral mandibular block improves pain relief and morphine consumption in mandibular osteotomies: A prospective, randomized, doubleblind, placebo-controlled clinical trial. Reg Anesth Pain Med. 2021, 46, 322–327. [Google Scholar] [CrossRef]
- Singh, B.; Bhardwaj, V. Continuous mandibular nerve block for pain relief: A report of two cases. Can J Anesth. 2002, 49, 951–953. [Google Scholar] [CrossRef]
- El-Anwar, M.W.; Hegab, A. Internal fixation of single mandibular fracture under mandibular nerve block. Oral Maxillofac Surg. 2016, 20, 57–61. [Google Scholar] [CrossRef]
- Öncül, A.M.T.; Çimen, E.; Kuçüükyavuz, Z.; Cambazoğlu, M. Postoperative analgesia in orthognathic surgery patients diclofenac sodium or paracetamol? Br J Oral Maxillofac Surg. 2011, 49, 138–141. [Google Scholar] [CrossRef]
- Jain, A.D.; Ravisankar, V.; Siva Bharani, K.; Sudheesh, K.; Tewathia, N. A comparative assessment of postoperative analgesic efficacy of lornoxicam versus tramadol after open reduction and internal fixation of mandibular fractures. Craniomaxillofac Trauma Reconstr. 2017, 10, 171–174. [Google Scholar] [CrossRef]
- Nezafati, S.; Khiavi, R.K.; Mirinejhad, S.S.; Ammadi, D.A.; Ghanizadeh, M. Comparison of pain relief from different intravenous doses of ketorolac after reduction of mandibular fractures. J Clin Diagn Res. 2017, 11, PC06. [Google Scholar] [CrossRef]
- Gobble, R.M.; Hoang, H.L.T.; Kachniarz, B.; Orgill, D.P. Ketorolac does not increase perioperative bleeding. Plast Reconstr Surg. 2014, 133, 741–755. [Google Scholar] [CrossRef]
- Solomon, D.H.; Furst, D.E.; Curtis, M.R. Overview of COX-2 selective NSAIDs. UpToDate. Available online: https://www-uptodate-com.medjournal.hmc.psu.edu:2200/contents/overview-of-cox-2-selective-nsaids?search=OverviewofCOX-2selectiveNSAIDs&source=search_result&selectedTitle=1∼150&usage_type= default&display_rank=1 (accessed on 6 August 2022).
- Straube, S.; Derry, S.; McQuay, H.J.; Moore, R.A. Effect of preoperative Cox-II-selective NSAIDs (coxibs) on postoperative outcomes: A systematic review of randomized studies. Acta Anaesthesiol Scand. 2005, 49, 601–613. [Google Scholar] [CrossRef]
- Pountos, I.; Georgouli, T.; Calori, G.M.; Giannoudis, P. Do nonsteroidal anti-inflammatory drugs affect bone healing? A critical analysis. Sci World J. 2012, 2012, 1–14. [Google Scholar] [CrossRef]
- Al-Waeli, H.; Reboucas, A.P.; Mansour, A.; Morris, M.; Tamimi, F.; Nicolau, B. Non-steroidal anti-inflammatory drugs and bone healing in animal models—A systematic review and metaanalysis. Syst Rev. 2021, 10, 201. [Google Scholar] [CrossRef]
- Kim, H.; Kim, D.H.; Kim, D.M.; et al. Do nonsteroidal antiInflammatory or COX-2 inhibitor drugs increase the nonunion or delayed union rates after fracture surgery? J Bone Joint Surg. 2021, 103, 1402–1410. [Google Scholar] [CrossRef]
- al Farii, H.; Farahdel, L.; Frazer, A.; Salimi, A.; Bernstein, M. The effect of NSAIDs on postfracture bone healing: A metaanalysis of randomized controlled trials. OTA Int. 2021, 4, e092. [Google Scholar] [CrossRef]
- Oksa, M.; Haapanen, A.; Furuholm, J.; Thore´n, H.; Snäll, J. Effect of perioperative systemic dexamethasone on pain, edema, and trismus in mandibular fracture surgery: A randomized trial. J Craniofac Surg. 2021, 32, 2611–2614. [Google Scholar] [CrossRef]
- Kormi, E.; Thore´n, H.; Sna¨ll, J.; Törnwall, J. The effect of dexamethasone on pain severity after zygomatic complex fractures. J Craniofac Surg. 2019, 30, 742–745. [Google Scholar] [CrossRef]
- Kormi, E.; Sna¨ll, J.; Koivusalo, A.M.; Suominen, A.L.; Thore´n, H.; Törnwall, J. Analgesic effect of perioperative systemic dexamethasone on blowout fracture surgery. J Oral Maxillofac Surg. 2017, 75, 1232–1237. [Google Scholar] [CrossRef]
- Lie´bana-Hermoso, S.; Manzano-Moreno, F.J.; Vallecillo-Capilla, M.F.; Olmedo-Gaya, M.V. Oral pregabalin for acute pain relief after cervicofacial surgery: A systematic review. Clin Oral Investig. 2018, 22, 119–129. [Google Scholar] [CrossRef]
- Ahiskalioglu, A.; Ince, I.; Aksoy, M.; Yalcin, E.; Ahiskalioglu, E.O.; Kilinc, A. Effects of a single-dose of pre-emptive pregabalin on postoperative pain and opioid consumption after doublejaw surgery: A randomized controlled trial. J Oral Maxillofac Surg. 2016, 74, 53.e1. [Google Scholar] [CrossRef]
- Benoliel, R.; Sharav, Y.; Eliav, E. Painful posttraumatic trigeminal neuropathy: A case report of relief with topiramate. Cranio. 2007, 25, 57–62. [Google Scholar] [CrossRef]
- de Carvalho Nogueira, E.F.; de Oliveira Vasconcelos, R.; Teixeira Correia, S.S.; Souza Catunda, I.; Amorim, J.A.; do Egito Cavalcanti Vasconcelos, B. Is there a benefit to the use of melatonin in preoperative zygomatic fractures? J Oral Maxillofac Surg. 2019, 77, 2017.e1. [Google Scholar] [CrossRef]
- ACS Trauma Quality Programs. Best Practices Guidelines For Acute Pain Management In Trauma Patients. 2020. Available online: https://www.facs.org/media/exob3dwk/acute_pain_guidelines.pdf (accessed on 24 July 2022).
- Chou, R.; Gordon, D.B.; de Leon-Casasola, O.A.; et al. Management of postoperative pain: A clinical practice guideline from the American Pain Society, the American Society of regional anesthesia and pain medicine, and the American society of anesthesiologists’ committee on regional anesthesia, executive committee, and administrative council. J Pain. 2016, 17, 131–157. [Google Scholar] [CrossRef]
- McDaid, C.; Maund, E.; Rice, S.; Wright, K.; Jenkins, B.; Woolacott, N. Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: A systematic review. NIHR Health Technology Assessment programme: Executive Summaries. Available online: https://www.ncbi.nlm.nih.gov/books/NBK56886/ (accessed on 24 July 2022).
- Elia, N.; Lysakowski, C.; Tramèr, M.R. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patientcontrolled analgesia morphine offer advantages over morphine alone? Anesthesiology 2005, 103, 1296–1304. [Google Scholar] [CrossRef]
- Holman, J.E.; Stoddard, G.J.; Horwitz, D.S.; Higgins, T.F. The effect of preoperative counseling on duration of postoperative opiate use in orthopaedic trauma surgery: A surgeon-based comparative cohort study. J Orthop Trauma. 2014, 28, 502–506. [Google Scholar] [CrossRef]
- O’Donnell, K.F. Preoperative pain management education: A quality improvement project. J PeriAnesthesia Nurs. 2015, 30, 221–227. [Google Scholar] [CrossRef]
- Horn, A.; Kaneshiro, K.; Tsui, B.C.H. Preemptive and preventive pain psychoeducation and its potential application as a multimodal perioperative pain control option: A systematic review. Anesth Analg. 2020, 130, 559–573. [Google Scholar] [CrossRef]
- Barca, I.; Colangeli, W.; Cristofaro, M.G.; et al. Effects of cold therapy in the treatment of mandibular angle fractures: Hilotherm system vs ice bag. Ann Ital Chir. 2016, 87, 411–416. [Google Scholar]
- Bates, A.S.; Knepil, G.J. Systematic review and meta-analysis of the efficacy of hilotherapy following oral and maxillofacial surgery. Int J Oral Maxillofac Surg. 2016, 45, 110–117. [Google Scholar] [CrossRef]
- Modabber, A.; Rana, M.; Ghassemi, A.; et al. Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: A randomized, observer-blind, prospective study. Trials. 2013, 14, 238. [Google Scholar] [CrossRef]
- Sun, Y.; Gan, T.J.; Dubose, J.W.; Habib, A.S. Acupuncture and related techniques for postoperative pain: A systematic review of randomized controlled trials. Br J Anaesth. 2008, 101, 151–160. [Google Scholar] [CrossRef]
- Wu, M.S.; Chen, K.H.; Chen, I.F.; et al. The efficacy of acupuncture in post-operative pain management: A systematic review and meta-analysis. PLoS ONE. 2016, 11, e0150367. [Google Scholar] [CrossRef] [PubMed]
- Lu, D.P.; Lu, G.P.; Kleinman, L. Acupuncture and clinical hypnosis for facial and head and neck pain: A single crossover comparison. Am J Clin Hypn. 2001, 44, 141–148. [Google Scholar] [CrossRef]
- Gupta, A.; Scott, K.; Dukewich, M. Innovative technology using virtual reality in the treatment of pain: Does it reduce pain via distraction, or is there more to it? Pain Med. 2018, 19, 151–159. [Google Scholar] [CrossRef]
- Kumari, S.; Bahuguna, R.; Garg, N.; Yeluri, R. Immersive and non-immersive virtual reality distraction on pain perception to intraoral injections. J Clin Pediatr Dent. 2021, 45, 389–394. [Google Scholar] [CrossRef]
- Rothgangel, A.; Bekrater-Bodmann, R. Mirror therapy versus augmented/virtual reality applications: Towards a tailored mechanism-based treatment for phantom limb pain. Pain Manag. 2019, 9, 151–159. [Google Scholar] [CrossRef]
- Patterson, D.R.; Jensen, M.P.; Wiechman, S.A.; Sharar, S.R. Virtual reality hypnosis for pain associated with recovery from physical trauma. Int J Clin Exp Hypn. 2010, 58, 288–300. [Google Scholar] [CrossRef]
- Kendrick, C.; Sliwinski, J.; Yu, Y.; et al. Hypnosis for acute procedural pain: A critical review. Int J Clin Exp Hypn. 2016, 64, 75–115. [Google Scholar] [CrossRef]
- Bowers, K.S. Imagination and dissociation in hypnotic responding. Int J Clin Exp Hypn. 1992, 40, 253–275. [Google Scholar] [CrossRef]
- Hilgard, M.T.; Hilgard, E.R.; Hilgard, J.R. Hypnosis in the relief of pain. New York: Brunner/Mazel Publishers, pp. 312. Am J Clin Hypn. 1994, 37, 60. [Google Scholar] [CrossRef]
- Chaves, J. Hypnosis in pain management. In Handbook of Clinical Hypnosis, 2nd ed.; Lynn, S., Rhue, J., Kirsh, I., Eds.; American Psychological Association: Washington, DC, USA, 1993; pp. 511–532. [Google Scholar]
- Hofbauer, R.K.; Rainville, P.; Duncan, G.H.; Bushnell, M.C. Cortical representation of the sensory dimension of pain. J Neurophysiol. 2001, 86, 402–411. [Google Scholar] [CrossRef]
- Rainville, P.; Duncan, G.H.; Price, D.D.; Carrier, B.; Bushnell, M.C. Pain affect encoded in human anterior cingulate but not somatosensory cortex. Science (1979) 1997, 277, 968–971. [Google Scholar] [CrossRef]
- Garland, E.L.; Brintz, C.E.; Hanley, A.W.; et al. Mind-Body therapies for opioid-treated pain: S systematic review and meta-analysis. JAMA Intern Med. 2020, 180, 91. [Google Scholar] [CrossRef] [PubMed]
- Chai, P.R.; Carreiro, S.; Ranney, M.L.; et al. Music as an adjunct to opioid-based analgesia. J Med Toxicol. 2017, 13, 249–254. [Google Scholar] [CrossRef] [PubMed]
- Agres, K.R.; Foubert, K.; Sridhar, S. Music therapy during COVID-19: Changes to the practice, use of technology, and what to carry forward in the future. Front Psychol. 2021, 12, 647790. [Google Scholar] [CrossRef] [PubMed]
- Lin, C.L.; Hwang, S.L.; Jiang, P.; Hsiung, N.H. Effect of music therapy on pain after orthopedic surgery—A systematic review and meta-analysis. Pain Pract. 2020, 20, 422–436. [Google Scholar] [CrossRef]
- Gogoularadja, A.; Bakshi, S.S. A randomized study on the efficacy of music therapy on pain and anxiety in nasal septal surgery. Int Arch Otorhinolaryngol. 2020, 24, e232–e236. [Google Scholar] [CrossRef]
- Gö kçek, E.; Kaydu, A. The effects of music therapy in patients undergoing septorhinoplasty surgery under general anesthesia. Braz J Otorhinolaryngol. 2020, 86, 419–426. [Google Scholar] [CrossRef]
- Schneider, M.A. The effect of listening to music on postoperative pain in adult orthopedic patients. J Holist Nurs. 2018, 36, 23–32. [Google Scholar] [CrossRef]
Medication | Mechanism of Action | Use in Facial Fractures | Ability to Reduce Pain | Ability to Decrease Rate of Opioid Use/Prescription |
---|---|---|---|---|
Acetaminophen | Inhibits the synthesis of prostaglandins | Can significantly lower narcotic usage, post-operatively [14,20] | Yes | Yes |
Lidocaine | Typically, a local anesthetic blocks voltage gated sodium channels | Use as a general anesthetic and injection can decrease pain and morphine use [14,23,24] | Yes | Yes |
Regional anesthesia/nerve blocks | Inhibition of nerve signal transmission with goal of preventing/relieving regional pain [35] | Shown to reduce pain in mandibular osteotomies and mandibular fractures [38,39] | Yes | Unknown |
NSAIDS | Inhibits cyclooxygenase enzymes | Better pain control when compared to opioids [41,42,43] | Yes | Yes |
Corticosteroids | Inhibits the synthesis of inflammatory proteins | Reduces pain after facial fracture surgery [51,52,53] | Yes | Unknown |
Gabapentinoids | Mimics GABA | Has the ability to decrease pain [54,55] | Yes | Unknown |
Melatonin | Acts on melatonin receptors in the suprachiasmatic nucleus | Better than placebo at reducing opioid dosage [57] | Unknown | Yes |
Therapy | Mechanism of Action | Use in Facial Fractures | Ability to Reduce Pain | Ability to Decrease Rate of Opioid Use/Prescription |
---|---|---|---|---|
Pre-operative counseling | Discussion of limitations for opiate use at the time of injury, prepare patients to decrease duration of post-operative opioid use [62] | Shown to reduce opioid use, duration of opioid use, and reported postoperative pain in orthopedic trauma and general surgery patients [62,63] | Yes | Yes |
Hilotherapy | 15 °C water is continuously circulated through a polyurethane mask applied directly to the surgical site [65] | Shown to reduce post-operative pain and edema in patients with zygomatic bone fractures [67] | Yes | Unknown |
Acupuncture | Pain relief by stimulation of the nerves, increases production of endorphins and enkephalins [19] | Shown to reduce post-operative pain and opioid-related side effects [68,69] | Yes | Yes |
Virtual reality | Redirects the senses and conscious attention toward the computerized images, reduces recognition of pain stimuli [71] | Has been used as a treatment for phantom limb pain and as a distraction for pediatric dental procedures [63,64]. Shown to reduce pain in patients with physical trauma when used in combination with hypnosis [73] | Yes | Unknown |
Hypnosis | Dissociation process utilizing hypnotic susceptibility and patient’s alerted state of consciousness. Utilizes influence of social and cognitive processes on patient’s compliance, expectations, and role enactment [76,77,78] | Shown to moderately reduce pain and required opioid dose in patients with acute, chronic, or post-operative pain [81] | Yes | Yes |
Music therapy | Functions through activation of the reward network in the brain leading to distraction and improved mood, rather than direct analgesia [82] | Shown to reduce anxiety and pain following septoplasty and septorhinoplasty surgeries [85,86] | Yes | Yes |
© 2024 by the author. The Author(s) 2024.
Share and Cite
Tucker, J.; Oxford, M.; Goldenberg, D.; Ziai, K.; Lighthall, J.G. Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use. Craniomaxillofac. Trauma Reconstr. 2024, 17, 61. https://doi.org/10.1177/19433875241236869
Tucker J, Oxford M, Goldenberg D, Ziai K, Lighthall JG. Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use. Craniomaxillofacial Trauma & Reconstruction. 2024; 17(4):61. https://doi.org/10.1177/19433875241236869
Chicago/Turabian StyleTucker, Jacqueline, Madison Oxford, Dana Goldenberg, Kasra Ziai, and Jessyka G. Lighthall. 2024. "Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use" Craniomaxillofacial Trauma & Reconstruction 17, no. 4: 61. https://doi.org/10.1177/19433875241236869
APA StyleTucker, J., Oxford, M., Goldenberg, D., Ziai, K., & Lighthall, J. G. (2024). Pain Management in Surgical Treatment of Facial Fractures: Alternative Approaches to Opioid Use. Craniomaxillofacial Trauma & Reconstruction, 17(4), 61. https://doi.org/10.1177/19433875241236869