A multimodal analgesic protocol reduced opioid use/misuse after third molar surgery

Abstract

Objective This institutional review board–approved prospective study was designed to assess the number of opioid doses available to patients from filled prescriptions (Rx) and the opioid doses taken and left over after adoption of a multimodal analgesic protocol to manage pain after surgery in 2018. Study Design The inclusion criteria were (1) American Society of Anesthesiologists risk classification I/II, (2) age 18 to 35 years, and (3) at least 2 lower third molars removed. The exclusion criterion was treatment for opioid addiction/abuse. All enrolled, consented subject-patients were treated with the multimodal analgesic protocol. In addition, subject-patients were given 2 Rx for 4 doses of hydrocodone 5 mg or acetaminophen 325 mg each: one Rx dated to be filled on the day of surgery, one Rx dated to be filled on any subsequent day; both Rx could be filled at the patient's discretion. Data were derived from an encounter form completed by the patient at surgery; a 14-day diary by the patient, which tracked opioid drugs taken; and the Rx filled as recorded in the North Carolina RxSentry Prescription Drug Monitoring Program. The primary outcome variable was the number of opioid doses filled by Rx for each subject-patient. The primary predictor variable was the multimodal analgesic protocol. Descriptive statistics were used. Results Data from 50 patients were analyzed. Of these patients, 32 (64%) were females. Median age was 22 years (interquartile range [IQR] 19–26 years). Twenty-nine (58%) subject-patients filled no Rx, 9 filled 1 Rx (18%), 12 filled 2 Rx (24%). Within the group that filled 1 Rx, 23 left-over doses out of 36 doses (64%) were not consumed. Within the group that filled 2 Rx, 36 left-over doses out of 96 doses (38%) were not consumed. Conclusions Outcomes suggest that implementation of a multimodal analgesic protocol with third molar surgery may be effective in reducing use and misuse of opioid drugs.