THE IMPROVEMENT OF POSTOPERATIVE ANALGESIA AT THE DENTAL IMPLANTATION: THE MULTIMODAL PRE-EMPTIVE APPROACH

THE IMPROVEMENT OF POSTOPERATIVE ANALGESIA AT THE DENTAL IMPLANTATION: THE MULTIMODAL PRE-EMPTIVE APPROACH

Larisa Sviridova

postgraduate student, doctor dentist-implantologist, Voronezh State Medical University named after N.N. Burdenko,

Russia, Voronezh

Alexander Sarychev

postgraduate student, doctor dentist-therapist, surgeon, Voronezh State Medical University named after N.N. Burdenko,

Russia, Voronezh

Dmitry Alexeev

postgraduate student, doctor dentist-orthodontist, Voronezh State Medical University named after N.N. Burdenko,

Russia, Voronezh

Oleg Shalaev

MDPhD, professor, Professor of the Department of Education of highly qualified personnel in dentistry, Voronezh State Medical University named after N.N. Burdenko,

Russia, Voronezh

Petr Popov

PhD, doctor anesthesiologist-resuscitator, Voronezh State Medical University named after N.N. Burdenko,

Russia, Voronezh

Alexei Morozov

MDPhD, professor, Head of the Department of Propaedeutic dentistry, associate professor, Vice-rector of educational work and information politics Voronezh State Medical University named after N.N. Burdenko,

Russia, Voronezh

ABSTRACT

Goal. The improving of postoperative pain relief at the dental implantation based on the use of the concepts of multimodal and pre-emptive analgesia.

Material. 200 patients was operated on in the scope of dental implantation. The differentiated composition of this initial sample: 100 patients with analgesia in the format of the "traditional approach" + 100 patients with analgesia in the format of the developed author's program.

Method. Modern scales for the quantitative assessment of pain syndrome (visual analogue scale, digital rating scale, mimic pain assessment scale). Variational statistics methods for analyzing results.

Result According to the studied indicators of postoperative pain syndrome, obvious statistically significant advantages of the developed program in comparison with the "traditional approach" were revealed.

Conclusions: The developed improved analgesia program for dental implantation should be recommended for implementation in the practice of dentistry based on the achieved clinical and statistical results.

Keywords: dental implantation, postoperative pain syndrome, multimodal analgesia, preemptive analgesia.

Actuality. Dental implantation belongs to the class of traumatic surgical interventions [1]. In this case, traumatization of the complex of hard and soft tissue structures of the dentoalveolar sphere becomes inevitable, which requires careful anesthetic management [2]. The so-called "traditional approach" to it includes only the use of local anesthetics in the modes of conduction and infiltration anesthesia. It is believed that this fully compensates for the antinociceptive needs of the body at the level of the intraoperative period. But this approach has a significant drawback - the inevitable development of pain in the postoperative period, which occurs after the end of the action of local anesthetics. A promising solution to this problem can be the use of the concepts of multimodal and proactive analgesia, which have earned the recognition of clinicians [3, 4]. However, at the level of dental implantation operations, it has not yet been implemented. These circumstances determine the high level of relevance of this study.

Methodology. 200 thematic patients were examined, among them 2 groups of 100 people were identified: group 1 – "traditional approach" to anesthesia – only local infiltration and conduction anesthesia in the intervention area; group 2 – the developed program of antinociceptive provision – sequential intravenous bolus administration of dexketoprofen at a dose of 25-75 mg and propofol at a dose of 50-200 mg immediately before local anesthesia and subsequent intervention.

Means for assessing the activity of the nociceptive system were used: a visual analogue scale (VAS), a digital rating scale (DRS), a mimic scale for assessing pain according to Wong Baker. The following indicators were studied: the number of patients with pain syndrome (absolute, relative), its maximum and "average" intensity, dynamics of intensity during the first day of the postoperative period; duration of clinically significant combat syndrome. Statistical methods: direct comparison of relative values, Shapiro-Wilk W-test, Student's parametric t-test. Accepted level of statistical significance of intergroup differences p < 0,05 [5, 6].

Results. In group 1: the number of patients without the development of pain – 0%; the number of patients with episodes of pain above an unacceptable level (≥ 4 points) – 100%; "statistically average" intensity – 4,81 ± 0,43 points; maximum intensity – 9 points; the duration of clinically significant pain syndrome (≥ 4 points) was 11,3 ± 1.86 hours. In group 2: the number of patients without the development of pain – 79%; the number of patients with episodes of pain above an unacceptable level (≥ 4 points) – 2%; "statistically average" intensity – 2,1 ± 0,35 points; maximum intensity – 3 points; duration of clinically significant pain syndrome (≥ 4 points) (in 21% of patients who developed any pain syndrome) – 4,6 ± 1,27 hours. p-level < 0,05 in all declared cases of intergroup comparisons.

The unequal effectiveness of the compared approaches to analgesia is visually confirmed by the fact that the amplitudes of the corresponding dynamic curves of the intensity of the postoperative painsyndrome have pronounced differences (fig. 1).

Figure 1. The dynamics of the intensity of postoperative pain syndrome during dental implantation under the conditions of using the "traditional approach" and the developed analgesia program

According to the studied indicators, obvious statistically significant advantages of the developed program in comparison with the "traditional approach" were revealed.

Consideration. The "traditional approach" to pain relief during dental implantation in the form of local monoanesthesia is not effective enough due to the development of a clinically significant postoperative pain syndrome. The developed pain relief program, which implements the concepts of multimodal and pre-emptive analgesia with the inclusion of local and systemic components, on the contrary, is a highly effective means of preventing postoperative pain during dental implantation.

References:

1. Blok M.S. Dental implantology: surgical aspects / M.S. Block. – Moscow, 2015. – 448 p. – ISBN 978-5-00030-23.
2. Surgical dentistry and maxillofacial surgery: national guidelines / A.A. Kulakov [et al.]. – Moscow, 2021. – 428 p. – ISBN 978-5-9704-6001.
3. Anesthesiology: national manual / A.A. Bunyatyan [et al.]. – Moscow, 2017. – 656 p. – ISBN 978-5-9704-3953-1.
4. Neurology: a national manual. Vol. 1 / E.I. Gusev [et al.]. – Moscow, 2018. – 880 p. – ISBN 978-5-9704-5173-1.
5. Rebrova O.Yu. Statistical analysis of medical data: application of the STATISTICA software package / O.Yu. Rebrova. – Moscow, 2002. – 312 p.
6. World Association of Medical Editors (WAME) [electronic resource]. – http://www.wame.org (date of application: 12.01.2021).