25
Volume3 Issue3
|
I
ssues and
P
eople
Inawide-rangingdiscussion on the use of opioids in themanagement of acute
post-surgical pain,CDA spokewithDrs.ChrisLee (CL) andBrianCairns (BC)
tohear their perspectives on this topic andwhat painmanagement protocols they
would recommend todentists.
➲
NSAIDs: thefirst lineof defence
CL:
Thefirst choice formanagingpost-operativepain is anon-opioidanalgesic suchas an
NSAID (e.g., ibuprofen, naproxen). Formost of our patients, post-surgical pain ismildandcan
bemanagedwithanon-opioidanalgesicwithappropriatedosingand regimen. Thego-to
medication formost ofmy fellowpractisingdentists is ibuprofen; a reasonabledosage is
600mgevery6hours,withamaximumdailydoseof 2400mg for analgesiceffect.
If thepatient can’t haveanNSAID, then the secondchoice is acetaminophen: 1000mgevery
6hours,withamaximumdailydoseof 4000mg.
BC:
Iwouldadd that for patientswho feel that over-the-counterNSAIDs, like ibuprofenand
naproxen, arenot effective, there is anoption touseaprescriptionNSAID. They’reall equally
effective. Agreat deal of clinical evidence supports theeffectivenessofNSAIDs for dental
procedures—particularlyones that causeacutepain.
➲
Medicationby the clock
CL:
Make sure thepatient takes themedicationby theclock, post-surgically for thefirst
coupleof days—NOTasneeded for pain.
BC:
After at least 2–3daysona regular dosepost-procedure, thepatient can takeanon-
opioidanalgesicasneeded for pain.
➲
Premedication
BC:
There’s excellent evidence for usinganNSAID—either aspremedicationor immediately
post-op—whileyou still have the local anestheticworking. Keep inmind it takes ibuprofen
about 40minutes to reach itspeakplasmaconcentration, so ideallyyou’dgive theNSAID
about 1hour beforeyou start theprocedure.
CL:
If I’mdoinga surgical extraction, having ibuprofen in thepatient prior tobeginning the
procedureprovides that pain-mediatingeffect post-procedure.
➲
Concerns aboutNSAIDs
BC:
Oneof themost commonproblemswithNSAIDs for acutepain treatment is stomach
upset or dyspepsia. Peoplearealsoconcernedabout developingulcers. But in fact, true
ulcers are far less commonwithacuteuseofNSAIDs to treat pain; ulceration isusually related
toahighdoseand longer exposure time.
ChrisLee
DDS,MSc
Dr. Lee is general
dentistwitha
background in
pharmacology,
basedat the faculty
of dentistry at
DalhousieUniversity,
where he directs
the general-practice
residency program
and the emergency
dental clinic.
BrianCairns
PhD,ACPR
Dr.Cairns is a
professor at the faculty
of pharmaceutical
sciences at the
University of British
Columbiaanda
licensed pharmacist.
He is president-elect
of theCanadianPain
Society.
