Details

Autor(en) / Beteiligte

• Black, Austin
• Laubert, Desiree
• Cockrum, Caleb

Titel

Propofol-Ketamine Versus Propofol-Remifentanil in Office-Based Facial Plastic Surgery: Comparison of Postoperative Pain

Ort / Verlag

ProQuest Dissertations & Theses

Erscheinungsjahr

2023

Quelle

ProQuest Dissertations & Theses A&I

Beschreibungen/Notizen

• Background: Numerous intravenous (IV) sedation techniques coupled with local anesthetic infiltration are utilized for office-based surgical procedures. Propofol and remifentanil infusions offer sedation and analgesia but increase the risk of commonly associated opioid analgesic side effects. Propofol with ketamine is an alternative to opioid use. This research compares postoperative pain scores in patients undergoing neck and facelift procedures in an office-based setting receiving IV sedation with either propofol-remifentanil (PR) or propofol-ketamine (PK). Methods: A retrospective chart review was performed on all patients who received a neck and/or facelift from September 2011 to March 2021 of a single office-based plastic surgery practice. Patient demographics, perioperative medications, perioperative events, vital signs, and perioperative pain scores were reviewed and recorded. A total of 512 records were included for analysis. IV for the PR group consisted of continuous infusions of propofol and remifentanil, while the PK group received a continuous propofol infusion with ketamine boluses. Postoperative and discharge pain scores were compared between groups. Results: The PR group consisted of 160 subjects, 12 male and 148 female (mean 58 years). The PK group consisted of 374 subjects, 22 male and 352 female (mean 58 years). Preoperative pain scores between groups were statistically significant ranging from 0 to 7 out of 10 (mean 0.7) in the PK group and 0 to 6 out of 10 (mean 0.4) in the PR group (p=0.014). Differences in postoperative and discharge pain were not statistically significant. Despite similar pain scores, more postoperative rescue analgesics (oral opioids and IV acetaminophen) were given in the PK group (p=0.0028). However, recovery to discharge time was decreased in the PK group (p<0.001). Conclusions: Although sedation with PK allowed for slightly lower postoperative and discharge pain scores when compared to PR, the differences were not statistically significant. The PK method showed increased use of rescue pain medication postoperatively but allowed for a shorter time from recovery to discharge. These findings provide insight into postoperative pain relief among patients undergoing neck and facelift procedures and support the use of non-opioid anesthetic management.