Narcotic Prescribing Habits and Other Methods of Pain Control by Oral and Maxillofacial Surgeons After Impacted Third Molar Removal
Narcotic Prescribing Habits and Other Methods of Pain Control by Oral and Maxillofacial Surgeons After Impacted Third Molar Removal
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DOI：
10.1016/j.joms.2013.04.031
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发表时间：
2013-09-01
影响因子：
1.9
通讯作者：
Laskin, Daniel M.
中科院分区：
文献类型：
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作者：
Mutlu, Ibrahim;Abubaker, A. Omar;Laskin, Daniel M.
目的：有研究表明，年轻人用于非医疗目的的麻醉品来源之一是未使用的阿片类药物，用于治疗拔除阻生第三磨牙后的疼痛。本研究的目的是确定口腔颌面外科医生是否常规使用比术后疼痛控制所需的更大剂量的麻醉药。第二个目的是确定他们是否使用镇痛药物以外的方法来减少术后疼痛，从而减少可能需要的麻醉剂量。患者和方法：随机抽取美国口腔颌面外科医师协会6个分会的100名会员进行问卷调查，问卷共有8个问题。被问及的问题涉及到是否会给拔除了阻生牙的患者常规开麻醉剂，最常用的药物，以及处方的剂量和片剂数量。参与者还被问及他们是否用非甾体抗炎药或处方抗炎药与麻醉剂一起治疗患者，是否注射类固醇，或术后使用持久局部麻醉剂。结果：384名受访者中只有2人表示他们没有给拔除埋伏牙的患者开麻醉药。氢可酮（5毫克）是最常用的麻醉品。药片的数量从10片到40片不等，但最常见的是20片。然而，80名受访者（22%）开了更多的处方，其中40人开了30片。此外，80%的受访者给患者注射了类固醇，62%的人在术后注射了持久的局部麻醉剂。只有34%的患者在术前使用非甾体类抗炎药，但66%的患者建议术后使用此类药物。结论：大多数口腔颌面外科医生处方的镇痛药物种类和剂量合适，并采用适当的辅助镇痛措施作为镇痛药物的补充。然而，我们的研究结果也表明，超过20%的患者在拔除阻生第三磨牙后，比一般情况下需要更多的药片来控制术后疼痛。这可能是年轻人转移药物和非医疗使用的一个来源，应该避免。(C) 2013年美国口腔颌面外科医师协会
Purpose: It has been suggested that a source of narcotics used for nonmedical purposes by young adults is the unused opioids prescribed for the management of pain after the removal of impacted third molars. The purpose of the present study was to determine whether oral and maxillofacial surgeons routinely prescribe larger amounts of a narcotic than would generally be needed for adequate postoperative pain control. A secondary goal was to determine whether they use methods other than analgesic drugs to minimize postoperative pain and thereby reduce the amount of narcotic that might be needed.Patients and Methods: An 8-question survey was sent to 100 randomly selected oral and maxillofacial surgeon members of the American Association of Oral and Maxillofacial Surgeons in each of the 6 association districts. The questions asked were related to whether a narcotic was routinely prescribed for patients who have had impacted teeth removed, the most common drug used, and the dosage and number of tablets prescribed. The participants were also asked whether they had pretreated patients with a nonsteroidal anti-inflammatory drug or had prescribed one along with the narcotic, had injected a steroid, or had used a long-lasting local anesthetic postoperatively.Results: Only 2 of the 384 respondents stated that they did not prescribe a narcotic for patients who had had impacted teeth removed. Hydrocodone (5 mg) was the most frequently prescribed narcotic. The number of tablets varied from 10 to 40, but the most common number was 20 tablets. However, 80 respondents (22%) prescribed more, with 40 prescribing 30 tablets. Also, 80% of the respondents injected their patients with a steroid, and 62% injected a long-lasting local anesthetic postoperatively. Only 34% pretreated their patients with a nonsteroidal anti-inflammatory drug, but 66% recommended such use postoperatively.Conclusions: Most oral and maxillofacial surgeons prescribe analgesic drugs of an appropriate type and dosage and use proper adjunctive pain control measures to supplement these drugs. However, our findings also indicated that more than 20% prescribe more tablets than would generally be necessary to control the postoperative pain after the removal of impacted third molars. This could be a source of drug diversion and nonmedical use by young adults and should be avoided. (C) 2013 American Association of Oral and Maxillofacial Surgeons