Management of Acute Postoperative Pain after Oral Surgery

This article provides a brief review of the acute pain mechanism as it relates to the effects of a surgical insult. A brief 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.

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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Oct 29, 2016 | Posted by in General Dentistry | Comments Off on Management of Acute Postoperative Pain after Oral Surgery
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