The Clinical Effect of Oral Gabapentin/Clonidine Premedication on Postoperative Outcomes in Patients Undergoing Orthognathic Surgery

Background: Postoperative acute pain management after maxillofacial surgery due to severity of pain and limitations of opioids use in these patients is of particular importance. The aim of this study was to evaluate the analgesic effect of oral gabapentin and clonidine combination and opioids requirements after surgery. Methods: This study was a randomized clinical trial (RCT) on 70 patients (18-55 yr old ASAI to II) undergoing various types of Orthognathic surgeries in Sina hospital affiliated to Tehran University of Medical Sciences, Tehran, Iran in 2016. The patients were randomly divided in two groups. Both groups received 1 gr (IV acetaminophen) 0.5 hour before the end of surgery. The control group received placebo and gabapentin/clonidine group received 300 mg gabapentin and clonidine 0.2mg orally 60 minutes before the induction of anesthesia. The pain severity score (assessed by VAS scale, the level of sedation (assessed by Sedation Agitation Scale), opioids requirement, nausea and vomiting were recorded in the post anesthesia care unit (PACU) 5 10, 20, 30 minutes and 3 hours after surgery. For rescue pain management intravenous morphine was administered. Results: Seventy patients were enrolled in this study. Gabapentin/ Clonidine increase extubation time (20.3±9.3min) (P<0.05) compared to control group (14.8±6.2 min). Gabapentin/ Clonidine decline the pain intensity, level of agitation and morphine requirement in the early minutes in recovery room. The incidence of PONV was also lower in gabapentin/clonidine group (5.7%) compared to control group (14.7%) p=0.005. Conclusion: Premedication of oral gabapentin/ Clonidine increases extubation time and sedation score in patients recovering from Orthognathic surgery and could reduce postoperative pain scores and opioids consumption in recovery room.