A multimodal analgesic protocol may reduce opioid use after third molar surgery: A pilot study

Magraw, Caitlin B.L.; Pham, Matthew; Neal, Timothy W.; Kendell, Barry D.; Reside, Glenn; Phillips, Ceib; White, Raymond P.

doi:10.1016/j.oooo.2018.04.007

Cited by 9 publications

(5 citation statements)

References 6 publications

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“…The multi-modal analgesic regimen to reduce inflammation and the incidence of nausea post-surgery was identical to that reported by Magraw et al [7]. All patients received IV antibiotic prophylaxis with ampicillin 1.0gm or clindamycin 300mg.…”

Section: Study Design/samplementioning

confidence: 89%

“…We reported some success in reducing the number of opioid doses in circulation with the analgesic regimen. Magraw et al in a retrospective pilot study reported 42% patients filled no opioid Rx [7]. Pham et al in a prospective observational study reported 60% subject-patients filled no opioid Rx [8].…”

Section: Introductionmentioning

confidence: 99%

“…The primary aim of this prospective, exploratory study was to assess acute pain levels experienced by patients for the 14 days after third molar surgery, all of whom were treated with the analgesic regimen as reported by Magraw et al and Pham et al [7,8]. We hypothesized that a multimodal analgesic regimen including liposomal bupivacaine could not only limit opioid use, but also eliminate patients' reported highest levels of acute pain after third molar surgery.…”

Section: Introductionmentioning

confidence: 99%

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A Multimodal Analgesic Regimen Including Liposomal Bupivacaine Moderated Acute Pain Levels After Third Molar Surgery

Matthew¹,

Caitlin²,

Timothy³

et al. 2021

Ann Anesth Pain Med

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This prospective, observational study was designed to moderate post-surgerical acute pain with a multimodal analgesic regimen including liposomal bupivacaine implemented for patients having third molar surgery. We hypothesized that acute pain would be reported no higher than 50% of the maximum possible. Patients and methods: Inclusion criteria: ASA risk classification I or II, age 18-35 years, and at least two mandibular third molars below the occlusal plane. All subject-patients were enrolled after consent for surgery and treated with the multimodal analgesic regimen. Data at surgery were completed by patient and surgeon. Acute pain data were derived from a 14-day diary completed by subject-patients each Post-Surgical Day (PSD) for the past 24 hours. The primary outcome variable was subjects experiencing “worst pain” which was defined as the three highest values on a 7 point Likert scale. Secondary outcome variables were the time in number of days until “little or no pain” were recorded. This was defined as the two lowest values on the same Likert scale. We used descriptive statistics to report outcomes. Results: Data were from 50 subjects. Thirty-two (64%) were female, median age was 22 years (IQR 19y, 26y), 48% were Caucasian, 25% Latino, 17% African-American, 10% other ethnicity. Surgeons’ median estimate of degree of difficulty was 9 out of 28 (IQR 5,15). Median surgery time was 32min (IQR 20,40). Thirty-nine patients had maxillary third molars removed; 86%, were vertical or distoangular. Bone was removed from 35%. All had both mandibular third molars removed; 54% were mesioangular or horizontal. Bone was removed from 95%. Eleven (23%) patients reported worst pain on PSD1, 17 (35%) on PSD2, 18 (37.5%) on PSD3, and 12 (25%) on PSD4. By PSD6, half of the subject-patients reported little or no pain. Conclusions: Outcomes for pain after third molar surgery were moderated by the multimodal analgesic regimen including liposomal bupivacaine, but the goal of all reporting pain 50% of the maximum possible was not achieved.

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Section: Study Design/samplementioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Multimodal Analgesic Regimen Including Liposomal Bupivacaine Moderated Acute Pain Levels After Third Molar Surgery

Matthew¹,

Caitlin²,

Timothy³

et al. 2021

Ann Anesth Pain Med

View full text Add to dashboard Cite

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“…12 In addition, a retrospective pilot study suggested that the use of a multimodal analgesic protocol including LB for third molar extraction resulted in a reduced number of opioid prescriptions compared with historic averages. 13 The purpose of this retrospective study was to compare opioid prescription volumes in MMEs in patients undergoing third molar extraction with or without the use of LB immediately after the procedure. The specific aims of the study were to compare prescribed MMEs, rate of prescription refills, and complication rates between groups.…”

mentioning

confidence: 99%

A Retrospective Cross-Sectional Study of the Effect of Liposomal Bupivacaine on Postoperative Opioid Prescribing After Third Molar Extraction

Lieblich

Misiek

Olczak

et al. 2021

Journal of Oral and Maxillofacial Surgery

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Reducing opioid prescriptions after third molar extraction may decrease the risk of opioid dependence. This study compared prescribed morphine milligram equivalents (MMEs) in patients undergoing mandibular third molar removal with and without use of liposomal bupivacaine (LB).Methods: This retrospective cross-sectional study included deidentified data from electronic medical records of patients who underwent extraction of $1 partial bony-or full bony-impacted mandibular third molar at 2 oral surgery centers in the United States in 2012 or 2018. The primary predictor variable was use of LB 133 mg. The primary outcome variable was total prescribed opioids in MMEs. The secondary outcome variable was rate of prescription refills. Both univariate and multivariable regression analyses were used to compare MMEs between groups with a significance level of P < .05.Results: The study sample included 600 subjects (n = 300 each for LB and non-LB groups). Mean age (22-24 years) and sex distribution (55%-58% female) were comparable between groups, although significant differences were observed in anesthesia type and race distribution (P < .05). In univariate analysis, the LB group was prescribed 59% fewer MMEs than the non-LB group (47.1 vs 113.8 MMEs; rate ratio, 0.41 [0.39-0.44]; P < .0001). After adjustment for age, sex, anesthesia type, American Society of Anesthesiologists physical status classification, and complications, the LB group was prescribed significantly fewer total opioids (adjusted MMEs, 44.9 vs 109.5; rate ratio, 0.41 [95% confidence interval, 0.39-0.44]; P < .0001) and had a significantly lower opioid prescription refill rate (3.3% vs 7.7%; odds ratio, 0.38 [95% confidence interval, 0.16-0.90]; P = .028) than the non-LB group. Complication rates were comparable between groups.Conclusions: Patients undergoing third molar extraction and receiving LB were prescribed significantly fewer opioids than patients who did not receive LB, with a lower refill rate. Use of LB may reduce opioid prescriptions for postsurgical analgesia.

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“… 2 , 3 Awareness, patient and family education, responsible prescribing practices, and multimodal analgesic strategies will allow significant reduction of unnecessary opiate prescriptions. 4 , 5 …”

mentioning

confidence: 99%

Pain Management for Dental Medicine in 2021: Opioids, Coronavirus and Beyond

Scrivani¹,

Keith²,

Kulich³

et al. 2021

JPR

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: Over the past year our attention has inevitably been on the coronavirus pandemic, the health and welfare of our families, patients, and office staffs as well as the re-opening of our dental practices. In addition, the opioid crisis continues, is very likely to worsen as a result of the pandemic and continues to be a challenge to Dentistry. National public health issues and healthcare disparities continue and have created a global concern for providing evidence-based, adequate pain management in the dental setting. We have brought together a group of national thought leaders and experts in this field who will share their insights on the current state of opioid prescribing in Dentistry and describe some of the exciting work being done in advancing pain management. The learning objectives for this conference proceedings were: Describing the implications of current public health concerns for safe and effective pain management in dental medicine. Identifying risk factors and understanding the current guidelines for the use of opioid and non-opioid medications in dental medicine. Analyzing the interprofessional collaborations necessary for effective pain management in dental medicine. Recognizing the challenges and opportunities brought about by the COVID-19 pandemic for the dental profession. Applying evidence-based strategies for managing the complex pain patient in the dental setting. Appraising new and future modalities for the assessment and management of orofacial pain.

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A multimodal analgesic protocol may reduce opioid use after third molar surgery: A pilot study

Cited by 9 publications

References 6 publications

A Multimodal Analgesic Regimen Including Liposomal Bupivacaine Moderated Acute Pain Levels After Third Molar Surgery

A Multimodal Analgesic Regimen Including Liposomal Bupivacaine Moderated Acute Pain Levels After Third Molar Surgery

A Retrospective Cross-Sectional Study of the Effect of Liposomal Bupivacaine on Postoperative Opioid Prescribing After Third Molar Extraction

Pain Management for Dental Medicine in 2021: Opioids, Coronavirus and Beyond

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