Abstract
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.
Highlights
The Joint Commission on Accreditation of Healthcare Organizations at the end of the last century challenged clinicians to better moderate acute pain, introducing a scale of 1 to 10 to measure pain levels in clinical settings
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
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
Summary
The Joint Commission on Accreditation of Healthcare Organizations at the end of the last century challenged clinicians to better moderate acute pain, introducing a scale of 1 to 10 to measure pain levels in clinical settings. This designation was adopted widely as a “a fifth vital sign” [1]. Clinicians including oral and maxillofacial surgeons were challenged to do more to reduce acute pain. Prescribing immediate acting opioid drugs was a common component of an analgesic regimen to reduce post-procedure pain. Consuming opioid Rx after third molar removal has been associated with higher odds of persistent opioid use among young, opioid-naïve patients [3]
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