A new prescribing strategy combined with multimodal analgesics reduces unused opioid doses: a prospective...

Following surgery, the primary challenge is to effectively manage acute pain while minimizing opioid usage. An established protocol in managing postoperative pain in third molar surgery has not been well described.

This prospective observational study included patients with at least 2 mandibular third molars removed in the University of North Carolina Oral Maxillofacial Surgery Clinic. Patients were treated with a multimodal analgesic regimen emphasizing medications with anti-inflammatory, long-acting, and short-acting properties, along with 2 separate prescriptions of 4 doses of Hydrocodone/acetaminophen (APAP). Daily post-surgery pain scores, medication use, and opioid prescription filled history were analyzed.

Data were analyzed from 96 patients. The combination of anti-inflammatory medications administered intra- and postoperatively, long-acting local anesthesia, and a limited number of prescribed opioids resulted in recovery to "little-to-no" pain for the average pain scores by day 4 and worst pain scores by day 6. Additionally, 52 patients (54%) did not fill an opioid prescription. Twenty-seven patients (28%) filled 1 prescription and 17 patients (18%) filled 2 prescriptions. On average, a 1.3 opioid dose was used post-operatively, ranging from 0 to 8 doses.

By combining medications with anti-inflammatory properties, long-acting local anesthesia, and a unique prescribing practice, we were able to achieve satisfactory pain control and limit leftover opiate use. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).