Effect of Dexmedetomidine on Blood Loss and Patient Outcomes in Orthognathic Surgery: A Randomised Clinical Trial.

Introduction And Aims: Blood loss is a common side-effect in orthognathic surgery. Deliberated hypotensive anaesthesia can reduce blood loss. The purpose was to evaluate the effect of add-on dexmedetomidine compared with the usual hypotensive drug bolus on blood loss and patient outcomes in orthognathic surgery.

Methods: This double-blinded randomised controlled trial study was conducted on patients with American Society of Anaesthesiology class I or II, and 18 to 45 years-old, scheduled for bimaxillary orthognathic surgery. Patients were randomly divided into 2 groups: study (add-on dexmedetomidine; D group) and control (usual bolus of the hypotensive drug; C group) by block randomisation. The primary outcome variables were blood loss, postoperative haemoglobin, and incidence of intraoperative blood transfusion. The secondary outcome variables were the stability of the vital signs, overall pain score and opioid requirement, anaesthetic time, quality of the operative visual field, surgeons' satisfaction, hospital stay length and side effects. Statistical significance was defined as P-value <.05.

Results: The sample was composed of 60 patients with a mean age of 25.93 (4.66) years and 26 (43.30%) were male. The blood loss for D and C groups was 401.67 (131.62) and 898.33 (548.58) mL, respectively (P < .001). The D group demonstrated a significantly lower overall pain score 2.43 (1.36) versus 4.10 (1.19) for C group. The quality of the surgical field using Fromme's scale was significantly higher in D group 0.93 (0.83) versus 2.53 (0.94). Nausea/vomiting was also significantly lower in D group.

Conclusions: Adding-on dexmedetomidine in orthognathic surgery decreases blood loss and improves patient outcomes, especially in overall pain score, quality of the surgical field, and incidence of nausea/vomiting.

Clinical Relevance: Dexmedetomidine can be considered a safe and effective medication for performing DHA in orthognathic surgery. Adding-on dexmedetomidine significantly reduced estimated blood loss by over 50% and improves patient outcomes.