Investigation of An Opioid Prescribing Protocol After Third Molar Extraction Procedures

Publication date: Available online 18 December 2018

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Paul C. Tompach, Chad L. Wagner, A.Brooke Sunstrum, Robert A. Nadeau, Harold K. Tu

Abstract

Purpose

The United States is experiencing an epidemic of opioid overdoses and deaths. The relationship between prescription opioids and opioid abuse is well- documented. Oral and maxillofacial surgeons and other dentists are proportionately among the most prevalent prescribers of opioids. Practitioners are looking for evidence-based ways to decrease excess opioid prescriptions while adequately managing postoperative pain. We recently analyzed the impact of a mandated non-opioid prescribing protocol at our institution. While broad guidelines have been useful for treating postoperative pain, there are no procedure-specific guidelines for managing pain following third molar extraction. The purpose of this study was to determine whether an opioid prescribing protocol was sufficient to decrease opioid prescribing after third molar extractions.

Materials and Methods

This retrospective study compares the use of opioids prescribed for patients undergoing third molar extraction prior to introducing and implementing a postoperative opioid prescribing protocol. Inclusion criteria was third molar extraction within the Division of Oral and Maxillofacial Surgery at the University of Minnesota during the fourth quarters of 2015 and 2017 with complete records.

Results

We observed decreases in the number of opioid prescriptions and an increase in non-opioid analgesics prescribed for all procedure codes following the implementation of the protocol. Higher CDT codes were associated with increased opioid prescriptions indicating increased surgical difficulty was a rationale for opioid prescriptions. A mean number of 15.9 opioid tablets were prescribed in 2015. This decreased to 11.5 tablets per prescription in 2017. No statistical difference was observed for average tablets for various CDT codes.

Conclusion

Data from this study suggest an acute postoperative pain opioid prescribing protocol leads to fewer opioid prescriptions after third molar extraction procedures, less variance in opioid prescribing among practitioners, and a decreased number of opioid tablets prescribed per patient while allowing for safe and effective management of acute postoperative pain.

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