Spring 2018

17 nmdental.org Submitted By: Lionel M. Candelaria DDS, FACS Diplomate of the American Board of Oral and Maxillofacial Surgery, Diplomate of the National Board of Dental Anesthesia Health care providers in the dental and medical profession must demonstrate safe and competent opioid prescribing for acute and postoperative pain in their patients. Responsible prescribing of opioids must be a priority, including accessing the state’s prescription-drug monitoring program as well as educating the patient and family about potential risks— and the safe use, storage and disposal—of opioid analgesics. Because prescribing protocols evolve over time, practitioners also should stay informed of the latest public health trends, including possible alternatives to opioid pain treatment. It is the position of NMDA that the practitioner-patient relationshipmustbeupheld, allowingforpractitioner judgment in the management of a patient’s pain—including drug types, dosages and treatment durations. Pain management decisions should be individualized and only determined after a careful assessment of the level of risk to—and condition of—the patient. While dental providers should ultimately make all final prescribing decisions, the recommendations in this article is intended to provide direction and serve as a supportive resource. Considerations and recommendations for the management of acute and postoperative pain include the following: • A nonsteroidal anti-inflammatory drug administered pre-emptively may decrease the severity of postoperative pain. • A perioperative corticosteroid (dexamethasone) may limit swelling and decrease postoperative discomfort after third-molar extractions. • A long-acting local anesthetic (e.g., bupivacaine, etidocaine, liposomal bupivacaine) may delay onset and severity of postoperative pain. • Providers should prescribe non-steroidal anti- inflammatory drugs (NSAIDs) as first-line analgesic therapy, unless contraindicated. If NSAIDs are contraindicated, providers should prescribe acetaminophen (N-acetyl-p-aminophenol [APAP]) as first-line analgesic therapy. Opioid Prescribing: Acute and Postoperative Pain Management continues on next page 