Pain after oral surgical procedures is one of the most studied models in pharmacology and pain research. Sensory nociception in the head and oral cavity is disproportionately greater than in most other areas of the body. Because of this phenomenon, appropriate preemptive and postoperative pain management is critical to achieve a successful outcome. This article provides the practitioner with a brief review of the acute pain mechanism as it relates to the effects of a surgical insult. An understanding of the physiologic modulation of acute pain establishes a rational framework for the concept of preemptive and postoperative analgesia. A brief review of commonly used analgesic agents is presented. Research in pain management and new drug development is ongoing as new concepts in neurophysiology and pharmacology are being elucidated.

Acute pain mechanisms

When examining how to manage acute postoperative pain in the oral and maxillofacial surgery patient, it is important to review the physiologic mechanisms involved in acute postsurgical pain. Webster’s dictionary describes pain as a basic bodily sensation induced by a harmful stimulus characterized by physical discomfort. When tissue homeostasis is disrupted by a surgical insult, autonomic, hormonal, and chemical changes that play a role in the subjective perception of pain are observed physiologically.

This article does not address every detail involved in the acute pain mechanism. Nonetheless, a simplified understanding of the neurophysiology of acute pain is important when reviewing pharmacotherapy Tables 1 and 2 .

Table 1

Commonly used oral narcotic analgesics

Drug	Trade Names	Usual Dose	Combination Drug
Codeine	Empirin with codeine Tylenol with codeine	30–60 mg	Aspirin (325 mg) Acetaminophen (300–650 mg)
Hydrocodone	Lortab, Norco, Vicodin, Maxidone	5.0, 7.5, 10.0 mg	Acetaminophen (500–750 mg)
Hydromorphone	Dilaudid	1–4 mg
Oxycodone	Percocet, Percodan, Roxicet, Roxiprin, Tylox	2.25–5.0 mg, 7.5 mg	Acetaminophen (300–500 mg) Aspirin (325 mg)
Pentazocine	Talacen, Talwin	12.5–25.0 mg	Acetaminophen (650 mg) Aspirin (325 mg)
Meperidine	Demerol	50–150 mg	None

 

From Fletcher MC, Spera JF. Pre-emptive and postoperative analgesia for dentoalveolar surgery. Oral Maxillofacial Sur Clin N Am 2002;14:137–51; with permission.

Table 2

Properties of oral narcotic analgesics

Drug	Analgesia	Sedation	Nausea or Vomiting	Constipation	Euphoria	Comment
Codeine	+	+++	++	++	+	Low potency
Hydrocodone	++	+	+	+	++
Hydromorphone	++	++	+	+	+++
Oxycodone	+++	++	+	+	+++
Pentazocine	++	+	+	+	+	CNS side effects
Meperidine	++	++	++	+	+++	Rarely indicated

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