AAOMS: Prescribing Recommendations for Acute and Post-Op Pain

The American Association of Oral and Maxillofacial Surgeons (AAOMS) issued recommendations regarding opioid prescribing for acute and postoperative pain management. 

In the AAOMS White Paper, the Association urges prescribing ibuprofen over opioids as first-line therapy to manage acute and post-op pain. The document emphasizes that, “While oral and maxillofacial surgeons should ultimately make all final prescribing decisions, the recommendations in this AAOMS White Paper are intended to provide direction and serve as a supportive resource.”

If the decision is made to initiate opioids, the AAOMS recommends that physicians start with the lowest effective dose for the shortest treatment duration possible. Physicians should avoid prescribing long-acting or extended-release opioids as first-line therapy. State prescription drug monitoring programs should be utilized and patients and families should be counseled about the risks associated with opioids and how to use them safely. Alternatively, ibuprofen and acetaminophen taken together can “rival opioids in their analgesic effect,” the authors state. 

Other major recommendations include:

• A nonsteroidal anti-inflammatory drug (NSAID) given pre-emptively may lower the severity of postoperative pain
• A perioperative corticosteroid (eg, dexamethasone) may minimize swelling and reduce postoperative discomfort after 3rd molar extractions
• A long-acting local anesthetic (eg, bupivacaine, etidocaine, liposomal bupivacaine) may delay onset and severity of postoperative pain
• NSAIDs should be prescribed as first-line therapy; if contraindicated, acetaminophen should be prescribed
• All instructions for patient analgesia and analgesic prescriptions should be carefully documented 
• The oral and maxillofacial surgeon should document their justification when deviating from prescribing guidelines

The document also addresses specific recommendations for oral and maxillofacial surgeons on educating patients about the recommended maximum daily doses, anticipated levels of pain relief, and exacerbations of chronic or recurrent pain. Lastly, surgeons should limit the prescription of opioids to patients currently taking benzodiazepines and/or other opioids due to the risk of respiratory depression.

For more information visit AAOMS.org.