Effects of beta-blocker on postoperative short-term outcomes following orthognathic surgery

Objectives: Improvement in patient outcome and reduced use of medical resources caused by the appropriate postoperative pain management is major concern of the anesthesiologists. Orthognathic surgery is one of the major maxillofacial procedures that cause severe postoperative pain. Therefore, we introduced intravenous patient-controlled analgesia (IVPCA) using fentanyl to alleviate postoperative pain. However, in spite of using IVPCA, some patients exhibited moderate to severe postoperative pain and also hemodynamic instability such as tachycardia. Perioperative use of beta-blockers has been advocated to suppress the cardiac events related to patient outcomes. This study was designed to evaluate the effects of postoperative continuous administration of landiolol, an ultra-short-acting beta1-adrenoreceptor antagonist, upon both hemodynamic variables and postoperative pain following orthognathic surgery. Methods: Thirty patients who underwent orthognathic surgery were enrolled in this study. All patients were anesthetized with sevoflurane and fentanyl combined with regional anesthesia. Patients were assigned to receive either landiolol (group L, n=15) or saline (group C, n=15). In group L, patients who exhibited postoperative tachycardia received a continuous intravenous administration of landiolol (4mcg/kg/min) for 24 hours. In group C, patients who did not show postoperative tachycardia received saline infusion. Postoperative pain was managed with PCA pump programmed to deliver 20 mcg of intravenous fentanyl with a lockout interval of 10 min. Blood pressure (BP), heart rate (HR), and visual analog scale (VAS) were evaluated at 1, 3, 6, 12, 24 hours following the operation. The cumulative fentanyl amount to be administered was also measured. Results: There were no significant differences between the groups for patients' characteristics. HR was significantly decreased (-20%) in the group L. BP, VAS and fentanyl amount were not different significantly between two groups. Conclusion: Postoperative administration of 4 mcg/kg/min of landiolol did not produce significant analgesia, although postoperative HR was significantly decreased.