Clinical Professor, Oral and Maxillofacial Surgery, University of Connecticut School of Dental Medicine, Avon, CT; and Avon Oral, Facial and Dental Implant Surgery, Avon, CT.
Clinical Professor, Program Director, Oral and Maxillofacial Surgery, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, LA.
J Oral Maxillofac Surg. 2021 Jul;79(7):1401-1408.e1. doi: 10.1016/j.joms.2021.02.012. Epub 2021 Feb 23.
Reducing opioid prescriptions after third molar extraction may decrease the risk of opioid dependence. This study compared prescribed morphine milligram equivalents (MMEs) in patients undergoing mandibular third molar removal with and without use of liposomal bupivacaine (LB).
This retrospective cross-sectional study included deidentified data from electronic medical records of patients who underwent extraction of ≥1 partial bony-or full bony-impacted mandibular third molar at 2 oral surgery centers in the United States in 2012 or 2018. The primary predictor variable was use of LB 133 mg. The primary outcome variable was total prescribed opioids in MMEs. The secondary outcome variable was rate of prescription refills. Both univariate and multivariable regression analyses were used to compare MMEs between groups with a significance level of P < .05.
The study sample included 600 subjects (n = 300 each for LB and non-LB groups). Mean age (22-24 years) and sex distribution (55%-58% female) were comparable between groups, although significant differences were observed in anesthesia type and race distribution (P < .05). In univariate analysis, the LB group was prescribed 59% fewer MMEs than the non-LB group (47.1 vs 113.8 MMEs; rate ratio, 0.41 [0.39-0.44]; P < .0001). After adjustment for age, sex, anesthesia type, American Society of Anesthesiologists physical status classification, and complications, the LB group was prescribed significantly fewer total opioids (adjusted MMEs, 44.9 vs 109.5; rate ratio, 0.41 [95% confidence interval, 0.39-0.44]; P < .0001) and had a significantly lower opioid prescription refill rate (3.3% vs 7.7%; odds ratio, 0.38 [95% confidence interval, 0.16-0.90]; P = .028) than the non-LB group. Complication rates were comparable between groups.
Patients undergoing third molar extraction and receiving LB were prescribed significantly fewer opioids than patients who did not receive LB, with a lower refill rate. Use of LB may reduce opioid prescriptions for postsurgical analgesia.
减少下颌第三磨牙拔除术后的阿片类药物处方可能会降低阿片类药物依赖的风险。本研究比较了使用和不使用包载布比卡因（LB）的患者在接受下颌第三磨牙拔除术后的吗啡毫克当量（MME）处方。
本回顾性横断面研究纳入了 2012 年或 2018 年在美国 2 家口腔外科中心接受至少 1 颗部分或完全骨内下颌第三磨牙拔除的患者的电子病历中匿名数据。主要预测变量是使用 LB 133mg。主要结局变量是 MME 中规定的总阿片类药物。次要结局变量是处方补药率。使用单变量和多变量回归分析比较了两组之间的 MME，显著性水平为 P <.05。
研究样本包括 600 名受试者（每组 300 名，LB 组和非 LB 组）。两组的平均年龄（22-24 岁）和性别分布（55%-58%为女性）相似，但麻醉类型和种族分布存在显著差异（P <.05）。在单变量分析中，LB 组的 MME 处方量比非 LB 组少 59%（47.1 与 113.8 MME；比率，0.41 [0.39-0.44]；P <.0001）。在调整年龄、性别、麻醉类型、美国麻醉医师协会身体状况分类和并发症后，LB 组的总阿片类药物处方明显减少（调整后的 MME，44.9 与 109.5；比率，0.41 [95%置信区间，0.39-0.44]；P <.0001），且阿片类药物处方补药率明显降低（3.3%与 7.7%；比值比，0.38 [95%置信区间，0.16-0.90]；P =.028）。两组的并发症发生率相似。
接受第三磨牙拔除术并接受 LB 的患者与未接受 LB 的患者相比，阿片类药物处方明显减少，补药率较低。LB 的使用可能会减少术后镇痛的阿片类药物处方。
