Distinguishing Postoperative Pain Development Trajectory After Orthognathic Surgery.

Abstract

Background: The lack of understanding of postoperative pain patterns makes it challenging to adopt refined pain management for orthognathic patients.

Purpose: The purpose was to characterize pain trajectories for the first 5 days following orthognathic surgery and identify factors associated with the trajectories.

Study design, setting, and sample: This retrospective cohort study was conducted at Peking University Hospital of Stomatology and included individuals aged ≥18 years who underwent orthognathic surgery. Patients with neuropsychiatric disorders or missing postoperative pain data were excluded.

Predictor variables: The predictor variable was postoperative pain intensity, assessed daily from days 1 to 5 after surgery using numerical rating scale.

Main outcome variables: The outcome variable was pain trajectory, determined by group modeling of self-reported pain over the first 5 postoperative days.

Covariates: Covariates comprised demographic, psychological, surgical, and perioperative variables.

Analyses: Descriptive statistics were calculated for each variable. Group-based modeling determined and clustered pain trajectories, and logistic regression identified independent factors. A P value of < .05 was considered significant.

Results: The sample was composed of 371 subjects with a median age of 25 years [21 to 29] and 272 (73.3%) were female. We identified three pain trajectories, and there were 208 (56.1%), 111 (29.9%), 52 (14%) subjects in Trajectories 1, 2, and 3 groups, respectively. Trajectory 1 showed gradually decreasing pain. Trajectory 2 showed mild pain that decreased until day 3 and then increased slightly on days 4 to 5. Trajectory 3 showed moderate pain decreasing until day 3, increasing to moderate on day 4 and severe on day 5. Increased Pain Catastrophizing Scale score (adjusted odds ratio (OR), 1.033, 95% confidence interval (CI), 1.006 to 1.060, P = .015), American Society of Anesthesiologists classification I (adjusted OR, 2.593, 95% CI, 1.102 to 6.100, P = .029), increased remifentanil dose (adjusted OR, 1.301, 95% CI, 1.038 to 1.632, P = .023), and dezocine used in the analgesia pump (adjusted OR, 4.883, 95% CI, 1.953 to 12.209, P = .001) were associated with increased likelihood of Trajectory 3. Male had significantly lower risk of Trajectory 2 (adjusted OR, 0.424, 95% CI, 0.264 to 0.680, P < .001) and Trajectory 3 (adjusted OR, 0.489, 95% CI, 0.287 to 0.834, P = .009).

Conclusion: Distinct pain trajectories were exhibited after orthognathic surgery. It recommends patient-specific management across different trajectories.