Tompach Paul C, Wagner Chad L, Sunstrum A Brooke, Nadeau Robert A, Tu Harold K
Clinical Assistant Professor, Division of Oral and Maxillofacial Surgery, University of Minnesota School of Dentistry, Minneapolis, MN.
Dental Student and Research Assistant, Division of Oral and Maxillofacial Surgery, University of Minnesota School of Dentistry, Minneapolis, MN.
J Oral Maxillofac Surg. 2019 Apr;77(4):705-714. doi: 10.1016/j.joms.2018.12.007. Epub 2018 Dec 18.
The United States is experiencing an epidemic of opioid overdoses and deaths. The relation 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 and adequately manage postoperative pain. The authors recently analyzed the impact of a mandated nonopioid prescribing protocol at their institution. Although broad guidelines have been useful for treating postoperative pain, there are no procedure-specific guidelines for managing pain after 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.
This retrospective study compared the use of opioids prescribed for patients undergoing third molar extraction before introducing and after implementing a postoperative opioid prescribing protocol. The inclusion criterion was third molar extraction performed at the Division of Oral and Maxillofacial Surgery at the University of Minnesota (Minneapolis, MN) during the fourth quarters of 2015 and 2017 with complete records.
The number of opioid prescriptions decreased and the number of nonopioid analgesics prescribed increased for all procedure codes after implementation of the protocol. Higher Current Dental Terminology (CDT) codes were associated with increased opioid prescriptions, indicating increased surgical difficulty was a rationale for opioid prescriptions. The mean number of opioid tablets per prescription was 15.9 in 2015 and decreased to 11.5 in 2017. No statistical difference was observed for average tablets for various CDT codes.
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, a decreased number of opioid tablets prescribed per patient, and safe and effective management of acute postoperative pain.
美国正经历阿片类药物过量使用和死亡的流行。处方阿片类药物与阿片类药物滥用之间的关系已有充分记录。口腔颌面外科医生和其他牙医按比例是阿片类药物最普遍的处方者之一。从业者正在寻找基于证据的方法来减少过量的阿片类药物处方并妥善管理术后疼痛。作者最近分析了他们机构一项强制性非阿片类药物处方方案的影响。尽管广泛的指南对治疗术后疼痛很有用，但对于第三磨牙拔除术后的疼痛管理尚无特定手术的指南。本研究的目的是确定阿片类药物处方方案是否足以减少第三磨牙拔除术后的阿片类药物处方。
这项回顾性研究比较了在引入和实施术后阿片类药物处方方案之前和之后为接受第三磨牙拔除术的患者开具的阿片类药物使用情况。纳入标准是2015年和2017年第四季度在明尼苏达大学（明尼阿波利斯，明尼苏达州）口腔颌面外科进行第三磨牙拔除且记录完整。
实施该方案后，所有手术编码的阿片类药物处方数量减少，非阿片类镇痛药的处方数量增加。较高的现行牙科术语（CDT）编码与阿片类药物处方增加相关，表明手术难度增加是开具阿片类药物的一个理由。2015年每张处方的阿片类药片平均数量为15.9片，2017年降至11.5片。不同CDT编码的平均药片数量未观察到统计学差异。
本研究数据表明，急性术后疼痛阿片类药物处方方案可减少第三磨牙拔除术后的阿片类药物处方，减少从业者之间阿片类药物处方的差异，减少每位患者开具的阿片类药片数量，并安全有效地管理急性术后疼痛。
