Alternating Current Iontophoresis for Control of Postoperative Pain
Control of early postoperative pain entails the use of various medications including acetaminophen, nonsteroidal anti-inflammatory drugs, selective cyclooxygenase-2 inhibitors, tramadol, and opioids. However, these medications should be carefully administered in patients with aspirin-exacerbated respiratory disease because some medications may trigger adverse reactions after maxillofacial surgeries. The goal of postoperative pain control in patients with aspirin-exacerbated respiratory disease is to eliminate pain without complications. Local anesthesia is an efficient tool for the control of postoperative pain after maxillofacial surgeries. We utilized a transdermal drug delivery system, iontophoresis by alternating current, in order to develop an alternative technique for administering local anesthetic to control postoperative pain in 2 patients with aspirin-exacerbated respiratory disease. A visual analogue scale was used to objectively measure the severity of pain. A 55-year-old woman who underwent mandibular wisdom tooth extraction and an 18-year-old woman who underwent sagittal split ramus osteotomy of the mandible both complained of pain multiple times. After application of iontophoresis, the visual analogue scale score was reduced to zero and postoperative pain could be controlled. There were no adverse events such as bronchospasm or skin irritation after the application of iontophoresis by alternating current.
Setup and position of electrodes in Case 1. The 2 electrodes were placed far apart on the facial skin on the side of the mandible where the wisdom tooth was extracted. One electrode was placed on the skin in front of the ear; the other was placed on the skin next to the left corner of the mouth.
Setup and position of electrodes on the mandible in Case 2. One electrode was placed on the skin in front of the ear; the other was placed on the skin next to the corner of the mouth of the patient who underwent sagittal split ramus osteotomy of the mandible (SSRO).
Trend in visual analogue scale (VAS) and the period of iontophoresis by alternating current (AC IOP) application and Rikkosan administration (arrow) after wisdom tooth extraction.
Trend in visual analogue scale (VAS) and the period of iontophoresis by alternating current (AC IOP) application after sagittal split ramus osteotomy of the mandible (SSRO).
Contributor Notes
This work did not receive any funding.
The authors have no conflicts of interest to declare.
These cases were presented at the annual meeting of The Japanese Dental Society of Anesthesiology, October 31, 2016.