Do oral and maxillofacial surgeons over-prescribe opioids after extraction of asymptomatic third molars?

Publication date: Available online 16 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Cory M. Resnick, Carly E. Calabrese, Salim Afshar, Bonnie L. Padwa

ABSTRACT

Purpose

Opioid abuse is a public health concern. Oral opioids are prescribed following removal of third molars, but the amount needed for adequate postoperative analgesia is unknown. The purpose of this study was to quantify opioid need after third molar extractions.

Methods

This is a prospective cohort study of consecutive patients that had asymptomatic third molars extracted with intravenous sedation at Boston Children's Hospital from June-October 2018 by 3 attending surgeons. To be included, patients had to have had four third molars removed. Patients were excluded if they had a concomitant procedure, preoperative infection, postoperative inflammatory complication, chronic pain condition, or did not complete the study. Postoperative prescriptions and instructions included: (1) oxycodone 5mg tablets, take 1 every 6 hours as needed, dispense #6; (2) ibuprofen 600mg tablets, take 1 every 6 hours as needed, dispense #20; (3) acetaminophen 325mg tablets, take 2 every 6 hours as needed, dispense #40. Subjects reported medication use via electronic questionnaire each day for 7 postoperative days. Descriptive statistics were calculated.

Results

81 subjects (56% female, mean age 19.4±7.7 years) were included. The average number of oxycodone tablets used was 0.04±0.24, and the highest daily use of oxycodone was on postoperative day (POD) 2 (1.0±0.0 tablets). Oxycodone was taken by 3 subjects (4%) on POD 1, 4 (5%) on POD 2, 2 (3%) on PODs 3 and 4, and 0 on PODs 5-7. Seventy-five subjects (93%) used no postoperative oxycodone; 466 prescribed oxycodone tablets remained unfilled or unused. ibuprofen 600mg was used for 4.6±2.2 PODs and acetaminophen 650mg was used for 3.4±1.9 days.

Conclusion

Oral opioid use following third molar extractions is minimal. Caution is necessary to avoid over-prescribing.

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