pain management

Intravenous Ketamine During Surgery

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A review articled carried out by the Cochrane Database of Systematic Reviews titled “Perioperative intravenous ketamine for acute postoperative pain in adults” written by Brinck et al. in 2018 (no. 12, art. no. CD012033) explored the efficacy and safety of intravenous ketamine in adults for pain management while having surgery under general anesthesia. The authors sought randomized, double-blind, controlled trials for inclusion in their analysis. The main outcomes were opioid consumption and pain intensity at 24 and 48 hours after surgery. The authors included 130 studies with 8,341 participants. Types of surgery included wisdom teeth extraction and among many others like lumbar fusion surgery, anterior cruciate ligament (ACL) repair, abdominal surgery, and elective caesarean section. The researchers found by looking at 65 of these studies that perioperative intravenous ketamine reduced postoperative opioid consumption over 24 hours by 8 mg morphine … Read more

FDA warns about dental problems from buprenorphine

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The U.S. Food and Drug Administration (FDA) has issued a safety concern regarding the medication buprenorphine which is a medication used to treat opioid use disorder, acute pain, and chronic pain. Buprenorphine is often used to reduce opioid withdrawal symptoms and the desire to use opioids, without causing the cycle of highs and lows associated with abusing opioid. The FDA warning issued on January 12, 2022, states that dental problems have occured when patients take medicines containing buprenorphine that are dissolved in the mouth. In the warning, the FDA said that the dental problems can include those of tooth decay, cavities, loss of teeth, and oral infections, and can occur in those without prior dental issues. As a result of this warning, the risk of dental problems occuring will be added to the prescribing information and the patient Medication Guide … Read more

Low-Dose Naltrexone as An Alternative to Opioids for Wisdom Teeth Removal

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Before on this site numerous posts have discussed how many feel dentists and oral surgeons prescribe (or in the past have prescribed) too many opioids for their patients to help manage pain of dental procedures like wisdom teeth removal, see for example the post Do Oral Surgeons Give Too Many Opioids for Wisdom Teeth Removal?. In recent years there have been investigations into alternatives to opioids for dental procedures and also for chronic pain management when opioids in the past were more regularly prescribed for as well. One such approach is to prescribe a combination of ibuprofen and acetaminophen as discussed in the articles New Research Being Conducted at Rutgers for Opioid Alternatives Could Lead to Less Potential Drug Abuse for those Having Wisdom Teeth Surgery and Reducing Opioids in Oral and Maxillofacial Surgery. Recently, there have been articles and … Read more

Important Studies on Opioid Prescribing: Implications for Dentistry

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Recently on this site several articles have appeared discussing opioid prescribing after wisdom teeth removal see for example the posts Do Oral Surgeons Give Too Many Opioids for Wisdom Teeth Removal? and Opioid Prescriptions From Dental Clinicians for Young Adults and Subsequent Opioid Use and Abuse. Very recently several interesting studies regarding opioid prescribing have published. The first study is titled “Trends in Opioid Prescribing for Adolescents and Young Adults in Ambulatory Care Settings” written by Hudgins et al. appearing in Pediatrics in June 2019 (vol.143, no. 6, e20181578). The article explored opioid prescribing for adolescents (ages 13 to 17) and young adults (ages 18 to 22) receiving care in emergency departments and outpatient clinics. Data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) and National Ambulatory Medical Care Survey (NAMCS) over the time period from January 1, 2005, … Read more

Do Oral Surgeons Give Too Many Opioids for Wisdom Teeth Removal?

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An interesting article titled “Do Oral and Maxillofacial Surgeons Over-Prescribe Opioids After Extraction of Asymptomatic Third Molars?” written by Resnick et al. appears in the 2019 edition of the Journal of Oral and Maxillofacial Surgery. The authors perform a study using patients at Boston Children’s Hospital in Boston, Massachusetts to determine how many opioids (taken as oxycodone) they take after having wisdom teeth extracted. This study was motivated by some recent studies that has shown that patients given opioids for dealing with pain after wisdom teeth surgery can go on to abuse opioids, see for example the posts Opioid Prescriptions From Dental Clinicians for Young Adults and Subsequent Opioid Use and Abuse and Persistent Opioid Use After Wisdom Teeth Removal. In the article the authors devised a study to determine how many narcotic and non-narcotic pain relief pills are taken … Read more