Questions & Answers: Where Do Opioids fit in the Management of Acute Post-Surgical Pain?
What is the ideal analgesic regimen for acute surgical procedures in the oral cavity, in particular 3rd molar extraction?
- The go to is ibuprofen: 600mg every 6 hours if the patient can tolerate ibuprofen.
When do you advise combining acetaminophen with ibuprofen, what dose to use, how long to treat post op, and when to consider using opioids?
- An alternative dose would be 500mg naproxen (Aleve) (2 tablets) every 12 hours.
- Otherwise alternate 600mg ibuprofen with 1000mg acetaminophen.
- The recommendation is to have continuous therapy for 3-7 days post-op.
What is the maximum daily dose of ibuprofen (2400 vs 3200) that a patient can take, and is there a “ceiling effect” with NSAIDs?
Generally, there is no evidence of benefit of going beyond 2400mg a day, because of the ceiling effect of using an NSAID.
What is the place of opioids in post-surgical acute pain management and what is the rationale for their use?
- Opioids are third-line medications, if you cannot use an NSAID, the next alternative is acetaminophen. ANd, if you cannot use acetaminophen, that’s when opioids become an option.
- It is important to acknowledge the patient’s pain and try to evaluate the patient’s situation and prescribe the best therapy for pain management. However, it is important to watch out for patients who are asking for refill for other reasons.
Do you routinely pre-medicate with NSAIDs as part of your analgesic regimen?
- There is a good evidence of using pre-medication or at least immediate post-op while the effect of local anesthestic is still in action.
Do practitioners tell patients to return unused doses to the pharmacy for destruction?
- Yes, practitioners as well as pharmacists should advise patients to return unused doses to their pharmacist who will dispose of any excess medication appropriately.
Are there any effective and proven methods by which I can screen patient for the potential of misuse or abuse of opioids?
- There is one tool: the Opioid Risk Tool
Watch the video interview