International journal of oral and maxillofacial surgery
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Int J Oral Maxillofac Surg · Sep 2014
Randomized Controlled Trial Comparative StudyComparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction.
Dexmedetomidine is an α2-adrenergic receptor agonist that causes minimal respiratory depression compared with alternative drugs. This study investigated whether combined dexmedetomidine/fentanyl offered better sedation and analgesia than midazolam/fentanyl in dental surgery. Sixty patients scheduled for unilateral impacted tooth extraction were randomly assigned to receive either dexmedetomidine and fentanyl (D/F) or midazolam and fentanyl (M/F). ⋯ The duration of analgesia after the surgical procedure was significantly longer in patients who received D/F (5.3 h) than in those who received M/F (4.1 h; P=0.017). The number of surgeons satisfied with the level of sedation/analgesia provided by D/F was significantly higher than for M/F (P=0.001). Therefore, dexmedetomidine/fentanyl appears to provide better sedation, stable haemodynamics, surgeon satisfaction, and postoperative analgesia than midazolam/fentanyl during office-based unilateral impacted tooth extraction.
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Int J Oral Maxillofac Surg · Sep 2014
Neurosensory assessment in patients with total reconstruction of the temporomandibular joint.
Somatosensory sensitivity and postoperative endogenous pain modulation have not been investigated in temporomandibular joint (TMJ) prosthesis patients. The objectives of this study were to assess somatosensory function at the TMJ and examine possible differences in conditioned pain modulation (CPM) between patients with total TMJ prostheses (n=7) and a reference group of healthy controls (n=20). Somatosensory abnormalities were assessed using quantitative sensory testing (QST), which encompasses thermal and mechanical testing procedures. ⋯ There was a significant decrease in pressure pain sensitivity at both sites during painful cold application in healthy controls (P<0.001) but not in patients (P=0.476). In conclusion, QST measures demonstrated somatosensory abnormalities in patients with total TMJ prostheses. Noxious conditioning cold stimuli evoked CPM-like effects in healthy subjects but not in patients with TMJ reconstruction.