Prévention et traitement de la douleur postopératoire en chirurgie buccale - Pain after oral surgery - Quick reference guide

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Posted on Nov 01 2005 To improve management of postoperative pain after oral surgery for inpatients and outpatients (excluding analgesia with 50/50 nitrous oxide/oxygen and surgery performed under general anaesthesia) Posted on Nov 01 2005

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C R A C T I C E GL I N I C A L P U I D E L I N E Q E F E R E N C E G U I D EU I C K R1

Preventing and managing postoperative pain
after oral surgery



Scope
To improve management of postoperative pain after oral surgery for inpatients and
outpatients (excluding analgesia with 50/50 nitrous oxide/oxygen and surgery
performed under general anaesthesia).

Key messages
1. Look forfactors predicting pain intensity and duration
2. Treat systematicallyand for a sufficiently long period, with 24-hour
cover
Follow upthe patient and adjust analgesic therapy
State when drugs should be takenon the prescription (intake
governed by drug pharmacokinetics and not by onset of pain

3.
4.

Three actions

1. Preoperative Î Anticipate
-Identify factors predicting pain intensity in order to decide:
-type of initial treatment (see Management table)

-duration of treatment
-Anticipate onset of pain by early prescription of analgesics, taking account of
speed of onset of action
Don t prolong nerve block (anaesthesia) unless really necessary
-

2. Immediate postoperativeÎ Manage
-Treat before onset of pain
-Cover the whole 24-hour period
-on the prescription how treatment is to be adjustedState
3. Delayed postoperativeÎ Follow-up and adjust
- D +1 on -wpuloolenf peohel tresuEnVRS or el( AV,Snoa s ac pirn aifytihe t tnenauq ehtitap2
-Have NS)
-Adjust treatment in steps


1 full guidelines (in English) and supporting scientific evidence (in French), see ForPrévention et
t2raitAeSment de lan adloougleuuerspcoalset;o pVéRraSt:o isriemeplne cvheirrubragie buccale (November 2005) - www.has-sante.fr
V : visual a l rating scale; NS: numerical scale



Risk factors affecting pain severity






pain Anatomical factors (depth of root, lingualDifficulty of surgery Preoperative
Duration of surgery of the tooth) inclinationPoor mouth hygiene
Surgeon’s level of (territory of the inferior alveolar nerve, after Smoking Site
removal
experience the mandibular third molar,Anxiety of
Depression implant placement or anaesthesia (local
infiltrationcial fac or regional block))
Negative so tors
Surgical technique (duration of surgery,

removal of distal bone and raising of a

lingual flap, vertical division of a tooth, use
of rotary instruments rather than bone

chisels)
Surgeon’s level f rience
o expe
Preoperative pain




Management





•Paracetamol 4 g/day


NSAID (propionic acidO l to 72 hr Limit
•ra
derivatives, fenamates)
•Tramadol 50-100 mg / 4-6 hr
• 60Codeine + paracetamolmg codeine + 1 g paracetamol / 6 hr
• arac

etamol T:Tramadol + p 50-100 mg / 4-6 hr
P: 1g / 6 hr



•)rh 27 D <NSAIon (rati tudjdsu A onetrr adam olmalo ,iwhtc doieNSAID + paracet
Look for complications causing
•Strong opioid
persistence of pain

•A l
na gesic (except NSAID) +
corticosteroids


NSAID: nonsteroidal anti-inflammatory drugs


Accompanying measures
- explain side effects

be taken and how to adjust dose on the prescription when drugs should - note
i
psycholog cal support and follow-up (information, telephone call)- provide


Dihydrocodeine is not recommended (no evidence of benefit in this indication)

2