Nonopioid Combination More Effective Than Opioids at Managing Postsurgical Pain
A combination of ibuprofen and acetaminophen was found to be superior to hydrocodone and acetaminophen in managing pain after impacted mandibular third-molar extraction surgery.
A combination of ibuprofen and acetaminophen was more effective at managing pain following impacted mandibular third-molar extraction surgery compared to hydrocodone, new study data published in the Journal of the American Dental Association found.1 The study authors said that the findings support the use of ibuprofen and acetaminophen as first-line therapy for acute pain management.
Nonopioid Combination More Effective Than Opioids at Managing Postsurgical Pain / Michael Flippo - stock.adobe.com
Although deaths involving opioids decreased in 2023 in the United States for the first time since 2018, they still remain significantly high.2 Pain following surgical procedures is common and can impact up to 80% of patients.3 Although opioids have long been prescribed to patients following surgery, concerns about inappropriate, excessive, and unsafe prescriptions have fueled research into alternative forms of pain management that carry less risk.
READ MORE: Cannabis Could Help Reduce Opioid Use in Patients with Chronic Pain
“Dentists are among the leading prescribers of opioid analgesics, accounting for 8,910,437 opioid prescriptions in 2022,” the authors wrote. “An estimated 5 million opioid-naïve young adults are exposed each year to opioids after third-molar extractions…If nonopioid combinations provide comparable pain relief with similar or greater satisfaction than opioid analgesia, the routine prescribing of opioids after third-molar extraction surgery could be eliminated.”
A team of investigators from Rutgers University conducted a study to determine if combination nonopioid analgesics are at least as good as opioid analgesics at managing acute postsurgical pain. The multisite, double-blind, randomized, stratified, noninferiority comparative effectiveness trial, called the Opioid Analgesic Reduction Study, compared patient-centered outcomes using 2 analgesic regimens after impacted partial or full bony mandibular third-molar extraction surgery.
The study cohort included 1815 adult patients with treatment planned for partial or full bony impacted mandibular third-molar extraction. Patients randomly received 5 mg of hydrocodone with 300 mg of acetaminophen or 400 mg of ibuprofen and 500 mg of acetaminophen. After an initial dose, the analgesic regimen was taken every 4 through 6 hours as needed. Patients were excluded if they had medical contraindications for taking ibuprofen, acetaminophen, or opioids, and had a social history of addiction or substance abuse.
The primary study outcomes were pain experience and participant satisfaction with medication. Secondary outcomes included the need for rescue medication, composite pain interference rating, overall sleep quality, adverse events, number of opioid tablets returned, and future opioid prescription within 6 months of extraction surgery.
The study found that the ibuprofen and acetaminophen regimen was superior to hydrocodone and acetaminophen in managing pain on both the first and second days and nights. Nonopioids were also seen to be noninferior on the third day and night and postoperative period. The group who received nonopioids had higher overall satisfaction at the postoperative visit, less need for rescue analgesics, and reported less pain interference.
Additionally, patients not taking opioids reported a lower frequency and severity of adverse events. Of the patients, 76 required a visit to the emergency clinic, with a similar prevalence between both groups. The most common adverse events reported by patients included fatigue and drowsiness, headache, and an inability to concentrate.
“Despite evidence to support the use of nonopioid alternatives, opioids are often prescribed by surgeons to preemptively address concerns about uncontrolled pain during the overnight and weekend hours when surgeons or follow-up care may not be readily available,” the authors concluded. “Across all patient outcomes, the Opioid Analgesic Reduction Study provides evidence that the combination of ibuprofen and acetaminophen should be the analgesic of choice for acute pain after impacted third-molar extraction surgery.”
READ MORE: Nonopioid Pain Management
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