J Dent Anesth Pain Med.  2015 Sep;15(3):141-146.

Circadian variation of IV PCA use in patients after orthognathic surgery: a retrospective comparative study

• Park S
• Chi SI
• Seo KS
• Kim HJ

Abstract

BACKGROUND
An understanding of the features of postoperative pain is essential for optimal analgesic dosing strategies. Using a visual analogue scale (VAS) score and patient controlled analgesia (PCA) infusion pattern analysis, an anesthesiologist can estimate when and how severely patients suffer from pain. Several reports have been published about circadian changes in the pain threshold. Postoperative pain was analyzed retrospectively in 250 patients who underwent orthognathic surgery.
METHODS
A total of 250 patients were allocated into two groups according to the time of recovery from anesthesia. Patients in the early group (group E) recovered from anesthesia before 06:00 p.m. Patients in the late group (group L) recovered from anesthesia after 06:00 p.m. All patients received intravenous patient controlled analgesia (IV PCA) at the end of the operation. The VAS score of pain intensity was measured. Self-administration of bolus analgesic from the IV PCA device was also analyzed according to actual time and elapsed time.
RESULTS
VAS scores showed no difference between the two groups except 36 hours after recovery from anesthesia. On POD1, there were two peaks for self-administration of bolus analgesics in group L and one peak in the morning for group E. Two peaks each in the morning and in the afternoon were shown in both groups on POD2.
CONCLUSIONS
Diurnal variance in pain should be considered for effective dosing strategies.

Keyword

Circadian; Orthognathic surgery; Patient controlled analgesia; Postoperative pain

MeSH Terms

Analgesia, Patient-Controlled
Analgesics
Anesthesia
Humans
Orthognathic Surgery*
Pain Threshold
Pain, Postoperative
Passive Cutaneous Anaphylaxis*
Retrospective Studies*
Analgesics

Figure

• 

  Fig. 1 Visual analogue scale score of pain intensity. Visual analogue scale (VAS) scores of pain intensity between group E and group L are compared over time. VAS score data are expressed as medians. X-axis values are expressed as elapsed time. VAS score of 36 hours after surgery is significantly higher in group L. *P < 0.05.

• 

  Fig. 2 Comparison of bolus attempts over time. Data are expressed as mean of bolus attempts every hour. X-axis values are expressed as elapsed time (right graph) and actual time (left graph). Mean values of bolus attempts between group E and group L decreased over time. Red and blue lines are nonlinear regression curve of group L and group E. Average values for attempts on the left graph on POD1 and POD2 show similar in group E and group L. Nonlinear regression equation: f(t) = (Y0-Plateau) · e-k·t + Plateau. Covariant: Y0 = 1.928, k = 0.1983, Plateau = 0.08079 (elapsed time in group E). Y0 = 2.198, k = 0.1503, Plateau = 0.0994 (elapsed time in group L). Y0 = 9.310, k = 0.1509, Plateau = 0.09091 (actual time in group E). Y0 = 25.14, k = 0.1459, Plateau = 0.1133 (actual time in group L). Ranges in 95% confidence intervals: 0.1731 < k < 0.2235 (elapsed time in group E), 0.1333 < k < 0.1672 (elapsed time in group L), 0.1310 < k < 0.1707 (actual time in group E), 0.1309 < k < 0.1609 (actual time in group L). The gradient of regression curve, k-values were statistically different (P < 0.05) in elapsed time graphs between two groups.

• 

  Fig. 3 Comparison of residuals of bolus attempts from nonlinear regression curve. Data are expressed as mean residuals in group E (black linear line) and group L (black dotted line) according to actual time and elapsed time after operation. Residuals were analyzed used with one-way t-test. 4 points marked with asterisks were significantly different in both groups from trends of nonlinear regression. *: P < 0.05

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