The Impact of Enhanced Recovery After Surgery in Orthognathic Surgery
Condition: Enhanced Recovery After Surgery; Hospital Stay; Postoperative Nausea and Vomiting; Pain, Postoperative
MeSH terms: Nausea; Vomiting; Pain, Postoperative; Postoperative Nausea and Vomiting
Study type: Observational

Summary: 
      Aim: Orthognathic surgeries are generally associated with blood loss, swelling, postoperative
      nausea vomiting (PONV), and pain. The aim of this study is to improve postoperative outcome
      in patients undergoing orthognatic surgeries by the use of Enhanced Recovery After Surgery
      (ERAS) protocols.

      Material methods: After Ethics Committee approval (2020/965), the data of 90 patients who
      underwent elective orthognathic surgery, were investigated. Following standard monitorization
      and general anesthesia; Group 1 patients were applied traditional approach and received
      intraoperative 10 mL/kg/h IV izolen infusion. Group 2 received ERAS approach. Patients in
      Group 2 did not preoperatively smoke for 48 hours, drank clear liquids until the last 2
      hours, and received 6 mL/kg/h IV izolen intraoperatively. In these; gastric aspiration was
      also applied before extubation, PONV prophylaxis and patient controlled analgesia was added
      to the routine plans for the first postoperative 48 hours. The primary endpoint was length of
      hospital stay. The secondary endpoints were intraoperative follow-up data, length of
      postanesthesia care unit (PACU) stay, numeric rating scale (NRS) pain scores, opioid
      consumption and PONV incidences through the postoperative first 48 hours, and satisfaction
      scores.
    

Detailed description: 
      Aim: Orthognathic surgeries are extensive surgeries including both soft and hard tissues of
      the facial region of the skull associated with blood loss, inflammatory reactions, massive
      swelling, postoperative nausea vomiting (PONV), and severe pain. Therefore; in most of the
      patients who are with dentofacial deformity and undergo orthognathic surgery, postoperative
      recovery generally requires a long troublesome period. The aim of this study is to improve
      postoperative outcome by the use of Enhanced Recovery After Surgery (ERAS) protocols.

      Material methods: After Ethics Committee approval (2020/965), the data of 90 patients who
      underwent elective orthognathic surgery, were investigated. Following standard monitorization
      and general anesthesia; Group 1 patients were applied traditional approach and received
      intraoperative 10 mL/kg/h IV izolen infusion. Rescue analgesics and PONV prophylaxis were
      applied when required through the postoperative first 48 hours. Group 2 received ERAS
      approach. Patients in Group 2 did not preoperatively smoke for 48 hours, drank clear liquids
      until the last 2 hours, and received 6 mL/kg/h IV izolen infusion intraoperatively. In these;
      gastric aspiration was also applied before extubation, PONV prophylaxis was supported
      routinely, and patient controlled analgesia was added to the routine analgesia plan for the
      first postoperative 48 hours. The primary endpoint was length of hospital stay. The secondary
      endpoints were intraoperative follow-up data, numeric rating scale (NRS) pain scores, opioid
      consumption, PONV incidences, length of postanesthesia care unit (PACU) stay, satisfaction
      scores of two groups through the postoperative first 48 hours.
    

Intervention name(s): Traditional Approach; Enhanced Recovery After Surgery (ERAS) Approach
Intervention type(s): Procedure; Procedure
Intervention description(s): Patients received intraoperative 10 mL/kg/h IV izolen infusion. Opioids and PONV prophylaxis were applied when required.; Patients did not preoperatively smoke for 48 hours, drank clear liquids until the last 2 hours and received 6 mL/kg/h IV izolen infusion intraoperatively. In these; gastric aspiration was applied before extubation, PONV prophylaxis was supported routinely, and patient controlled analgesia was added to the routine analgesia plan for the first postoperative 48 hours.
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients eligible for orthognathic surgery Patients who were operated under either the
        traditional approach or the Enhanced Recovery After Surgery (ERAS) approach Patients aged
        between 18 and 40 years of age American Society of Anesthesiologists (ASA) physical status
        of 1-2
      
Keywords: Orthognathic surgery; Enhanced recovery after surgery (ERAS); Analgesia; Postoperative nausea vomiting (PONV); Satisfaction