How to avoid pain-abstract
How to avoid pain, swelling, nausea, vomiting and infection after the surgery Ting-Chen Lu, Chuan-Fong Yao
Pain and swelling: pain occurred after the first incision in the mucosa. Therefore, before the operation, we use nerve block to prevent the pain stimulation. And the inflammatory responses can be inhibited by COX inhibitor and corticosteroid. For the swelling process, corticosteroid can be used. Reviewing the RCT studies, the present findings suggest that the administration of corticosteroid in oral surgery decreases edema and pain significantly. Using the corticosteroid is not associated higher risk of infection and with minimum risk of other side effects.
Infection: The meta-analysis studies, which comparing the single dose, short-term and long –term prophylactic antibiotics use, all concluded significant reduction of infection rate with the application of antibiotic prophylaxis. However, selection of single-dose, short-term or long-term regimen could be based on surgeon’s experience and condition of each individual patient. In Chang-Gung memorial hospital, we used cefazolin 1 g before the operation and 500 mg every 4 hours. IV form cefazolin Q8H was used with clindamycin 300 mg Q8H after the operation for 2 days. Amoxicillin 500mg Q8H are taken orally after discharge.
Nausea and vomiting: There is convincing evidence that eight drugs reduce PONV by a similar amount: cyclizine, droperidol, granisetron, metoclopramide, ondansetron, tropisetron, dolasetron and dexamethasone. However, there is only limited evidence that more drug is more effective for dexamethasone and ondansetron. Evidence for differences in the efficacy of these eight drugs is not convincing. Dexamethasone is effective in reducing the incidence of PONV in both early (< 6 hrs) and late (24 hrs) stage after operation.A 4-mg to 5-mg dose of dexamethasone has similar clinical effects as the 8-mg to 10-mg in the reduction of PONV.