Reducing Opioids in Oral and Maxillofacial Surgery

An interesting article titled “Opioid Prescribing Can Be Reduced in Oral and Maxillofacial Surgery Practice,” written by Tatch appears in the 2019 edition of the Journal of Oral and Maxillofacial Surgery. In the article the author discusses the results of implementing an office protocol for pain management to reduce opioid use in oral and maxillofacial surgery during a three year time period. Results from a similar study were presented previously in a post titled Oral and Maxillofacial Surgeons Current Perspectives on Opioid Prescribing.

In the article the author discusses how a risk of opioids is dependence which can develop after just one week of using. The author came up with a 3-year retrospective study to measure changes in opioid use after the introduction of an office protocol which was designed to offer alternatives to pain relief. In the study a total of 6,055 patients were seen over a three year time period from March 2015 until March 2018 at the oral surgeon’s office in Gurnee, Illinois. A total of 2,016 patients were seen from March 2015 until March 2016 prior to implmenting the office protocol. The office protocol was implemented in March 2016 and 2,005 patients were seen in the subsequent year and 2,034 patients were seen in the year after. Patients were included who underwent different procedures including wisdom teeth removal, bone reconstructions, sinus lifts, and dental implantations. The office protocol that was implemented included using a VEGA Recovery Kit made by the company StellaLife consisting of homeopathic ingredients three days prior to surgery and for seven days after surgery. Patients were also given acetaminophen in 1,000 mg tablets and ibuprofen in 400 mg tablets.

homeopathic medications - Reducing Opioids in Oral and Maxillofacial Surgery
This image is from the Wisconsin Department of Natural Resources on Flickr and has a Creative Commons license

The author found that for the year prior to implementation of the office protocol 1,184 of the 2,016 patients seen (58.7%) filled opioid prescriptions, in the year after implementation of the office protocol 899 of the 2,005 patients seen (44.8%) filled opioid prescriptions, and in the second year after implementation of the office protocol 387 of the 2,034 patients seen (19.0%) filled opioid prescriptions. These values of opioid prescriptions filled were all statistically significantly smaller than the preceding year. The author states

“In the past 2 years, the author has effectively decreased the number of hydrocodone or oxycodone prescriptions filled.”

Therefore there was around a 3-fold decrease in the number of opioid prescriptions filled over the three year study period. However, the author did not attempt to measure how satisfied the patients were with the pain control they received. Therefore the author suggests in a future study that patients are given a questionnaire to evaluate pain control after the surgical procedures. He also suggests expanding the study to using more than just one site for the surgeries. The author feels that oral and maxillofacial surgeons could further decrease the number of opioids they prescribe but recognize that it is important to discuss pain control with their patients.

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