Opioids for pain after oral surgery

Abstract

Aim To describe the role of opioids in the management of pain after oral surgery. Materials and methods A review of the literature describing the pharmacokinetics, benefits and harms of opioids in terms of systematic review evidence, interactions, use in children, pregnancy and breastfeeding. Results A 10‐mg intramuscular dose of morphine is recognised as a very effective analgesic for post‐operative pain with a number needed to treat (NNT) of 2.9. Codeine 60 mg has an NNT of 16.7 suggesting poor analgesic effectiveness, but in combination with 1 g paracetamol is an effective analgesic for the management of post‐operative pain with an NNT of 2.2. Conclusions Morphine is effective for severe pain experienced by inpatients undergoing oral surgery, ideally administered intravenously or alternatively by intramuscular injection. Codeine is very effective when combined with paracetamol and is suitable for day‐case and outpatient oral surgery experiencing moderate to severe pain.

Non‐steroidal anti‐inflammatory drugs for pain after oral surgery

“…It would therefore seem appropriate to use one of these NSAIDs. The routine use of COX‐2‐selective NSAIDs for post‐operative pain relief for oral surgery is not advised; instead, where the risks of prescribing NSAIDs (gastric toxicity, bleeding, interactions, intolerance) outweigh the benefits, we would recommend prescribing paracetamol alongside a weak opiate such as codeine or tramadol. In summary, the NSAIDs are very useful analgesics for managing post‐operative pain; however, their adverse effects must be borne in mind when prescribing, and it is advisable to use the lowest effective dose for the shortest duration in post‐operative pain.…”

“…Diclofenac potassium was developed to manage migraine pain. Diclofenac sodium is far more frequently prescribed than the potassium derivative of the drug. The immediate‐release preparation is of more use in the management of post‐operative pain. Etodolac has comparable efficacy to naproxen; it is licensed for symptomatic relief of arthritis.…”

“…This third article in the series discusses the use of NSAIDs in the management of pain in patients undergoing oral surgery procedures in primary and secondary care. Other articles in this series describe pain pathways and the use of paracetamol and opioids in the management of pain following oral surgery and pain measurement.…”

Measuring pain after oral surgery

“…This fifth article in the series discusses the practicalities of how to measure a patient's pain after surgery. Other articles in this series describe pain pathways and the use of paracetamol, Non‐steroidal anti‐inflammatory drugs and opioids in the management of pain following oral surgery.…”

Pain pathways and pre‐emptive and protective analgesia for oral surgery

“…This first article in the series describes how the patient's post‐operative pain experience can be improved by understanding the underlying principles. Other articles in this series describe the use of paracetamol, non‐steroidal anti‐inflammatory drugs (NSAIDs) and opioids in the management of pain following oral surgery and the measurement of pain after oral surgery.…”