Postoperative Pain Relief in Dentistry- Part 2

(This article is part 2 of the 2-part series on postoperative pain relief in dentistry)

Abstract

Pain is one of the main problems in the early postoperative period. As seen in Part 1, it is treated in modern outpatient practice with non-narcotic analgesics which, in addition to the analgesic effect, have antipyretic, anti-inflammatory and desensitizing properties. This part discusses how to prescribe which NSAID and when, along with their interactions with other systemic drugs.

(It is suggested to read Part 1 of this article series which describes the names, types, mechanisms, pharmacokinetics, pharmacodynamics and side effects of NSAIDs.)

Rational administration and dosage of NSAIDs

Before prescribing an NSAID to a patient, it is necessary to decide whether this drug is really indicated for him. Taking into account modern standards of pharmacotherapy of an existing disease, it is necessary to develop a treatment program with minimally effective doses in the shortest possible time.

• As a rule, in acute cases, the beginning of treatment (first hours, days) with high doses with a quick transition to maintenance is more effective and safe than uncontrolled long-term use.
• NSAIDs are unequal in their damaging effect on the stomach and intestines, liver, kidneys and blood cells, which should be taken into account when planning therapy, especially long-term therapy, and if necessary, the use of these drugs in patients with pathology of the above organs, elderly and senile age.
• Each patient has his/her own NSAID drug(s) with the best efficacy and safety profile. It is impossible to predict the patient's response to a particular drug. The ineffectiveness of one of the drugs does not mean the ineffectiveness of the subgroup as a whole. To determine the optimal drug in case of need for long-term treatment, it is possible to use sequential trial treatment with various NSAIDs with a comparative assessment of its results.
• When evaluating the effectiveness, it must be taken into account that an analgesic effect is noted first (after hours of administration), and the manifestation of the actual anti-inflammatory effect is observed later, its evaluation should be carried out no earlier than after 2 weeks of regular use (oxicam - after 4 weeks).

As a rule, NSAIDs are used after meals, in a sitting position, drinking 150-250 ml of boiled water at room temperature.

The time of taking the drug should be associated with the part of the day when the symptoms of the disease are most pronounced. By this time, the peak action of the drug should be observed. Under this condition, it is not necessary to ensure the action of the drug throughout the day, an "asymmetric" intake of 1-2 times a day is possible.

• The simultaneous use of two or more NSAIDs is impractical due to the lack of evidence of the rationality of such combinations, the presence of data on the competition of various NSAIDs for binding to blood proteins, which may increase the risk of side effects. An exception is possible with a combination of fast- and short-acting dosage form at different times of the day.

‘Effective’ Order - How to prescribe?

When prescribing to patients, it is important to know what effect is most desired - anti-inflammatory or analgesic. Then, you can prescribe according to the severity of the condition.

According to the anti-inflammatory effect of medium doses, NSAIDs can be arranged in the following order (maximum to minimum):

• Indomethacin
• Flurbiprofen
• Diclofenac sodium
• Piroxicam
• Ketoprofen
• Naproxen
• Ibuprofen
• Amidopirin
• Aspirin

According to the analgesic effect of medium doses, NSAIDs can be arranged in the following order (maximum to minimum):

• Ketorolac
• Ketoprofen
• Diclofenac sodium
• Indomethacin
• Flurbiprofen
• Amidopirin
• Piroxicam
• Naproxen
• Ibuprofen
• Aspirin

Comparative characteristics of the analgesic effect of NSAIDs

Using aspirin as an example (Reference -Drugs of Choice from the Medical Letter, 1995)