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Advances in pain management in oral surgery
*Corresponding author: Ankita Bhardwaj, Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India. ankitabhardwaj2004@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Bhardwaj A, Deep A, Chadha A, Kumar Y. Advances in pain management in oral surgery. J Academy Dent Educ. 2025;11:68-70. doi: 10.25259/JADE_78_2024
Abstract
Recent advancements in post-operative pain management for oral surgery have emphasized enhancing patient comfort, expedited recovery times, and reducing reliance on opioids. Key strategies include the implementation of multimodal analgesia, which involves the concurrent use of multiple analgesic agents to achieve superior pain control with a reduced incidence of side effects. Regional anesthesia techniques, such as nerve blocks, offer targeted pain relief, thereby diminishing the necessity for systemic opioid administration. The integration of enhanced recovery after surgery protocols has optimized perioperative care, facilitating faster recovery and shorter hospital stays. Minimally invasive techniques, including laser-assisted surgery and piezosurgery, have been developed to minimize tissue trauma, consequently reducing post-operative pain and accelerating the healing process. Patient-controlled analgesia (PCA) systems empower patients to self-administer analgesics within prescribed limits, enhancing patient autonomy and satisfaction. The use of long-acting local anesthetics, such as extended-release formulations, provides prolonged analgesia, thus decreasing the requirement for additional pain medications. Furthermore, non-pharmacological interventions, such as cognitive-behavioral therapy and acupuncture, are increasingly utilized as adjuncts to pharmacological treatments, offering holistic pain management by addressing both the physical and psychological aspects of pain. Collectively, these advancements represent a significant shift toward more effective, individualized, and patient-centered pain management in the context of oral surgery, aiming to optimize clinical outcomes and enhance the overall patient experience.
Keywords
Enhanced recovery after surgery protocols
Long-acting local anesthetics
Minimally invasive techniques
Multimodal analgesia
Non-pharmacological interventions
Oral surgery
Pain management
Patient-controlled analgesia
Regional anesthesia
INTRODUCTION
Effective pain management after oral surgery is essential for several reasons. Primarily, it ensures patient comfort and satisfaction, which is crucial for a positive post-operative experience.[1] Proper pain control facilitates quicker recovery by minimizing physiological and psychological stress, reducing the risk of complications such as infection, dehydration, and malnutrition. Furthermore, managing acute pain effectively can prevent the development of chronic pain conditions. With the ongoing concerns regarding opioid dependency, it is also important to minimize the use of opioids by employing alternative pain management strategies, including non-opioid medications and non-pharmacological interventions. In addition, effective pain management aids in the restoration of essential oral functions such as speaking, chewing, and swallowing, which are vital for overall health and quality of life. Psychologically, adequate pain control can reduce anxiety and fear related to surgery, improving the patient’s mental well-being and preventing post-operative depression and anxiety. Overall, pain management is a critical component of post-operative care that significantly influences patient outcomes and quality of life.
The management of post-operative pain in oral surgery has seen substantial advancements, aiming to enhance patient comfort, expedite recovery times, and reduce the dependence on opioid analgesics. This review systematically examines recent innovations in pain management, focusing on multimodal analgesia, regional anesthesia, enhanced recovery after surgery (ERAS) protocols, minimally invasive techniques, patient-controlled analgesia (PCA), long-acting local anesthetics, and non-pharmacological interventions.
Multimodal analgesia,[2] which involves the concurrent use of multiple analgesic agents with different mechanisms of action, has been demonstrated to provide superior analgesic efficacy and a more favorable side-effect profile compared to monotherapy. Regional anesthesia, utilizing techniques such as peripheral nerve blocks, offers localized anesthesia and analgesia, resulting in improved patient outcomes and a reduced requirement for systemic opioids. The adoption of ERAS protocols in oral surgery has streamlined perioperative care, facilitated rapid recovery, and minimized the length of hospital stays. Innovations in minimally invasive techniques, including laser-assisted surgery and piezosurgery, have significantly reduced intraoperative and post-operative tissue damage, thereby decreasing pain and accelerating the healing process.
The implementation of PCA has allowed for patient-specific analgesic administration, improving patient autonomy and satisfaction while optimizing pain control. The use of long-acting local anesthetics, such as liposomal bupivacaine, has extended the duration of post-operative analgesia, thereby diminishing the need for supplementary analgesic interventions. Non-pharmacological interventions, encompassing modalities such as cognitive-behavioral therapy, acupuncture, and relaxation techniques, have been integrated into multimodal pain management strategies to address both the physiological and psychological dimensions of pain.
These advancements collectively signify a transformative shift in the approach to pain management in oral surgery, offering a more effective, personalized, and patient-centric model of care. Ongoing research and clinical refinement are essential to further optimize these strategies, striving for maximal analgesic efficacy with minimal adverse effects.
Pain management is a critical component of oral surgery, as effective control of post-operative pain can significantly impact patient recovery and satisfaction. Traditional methods often relied heavily on opioids, but recent advancements have introduced more comprehensive and tailored approaches. This paper examines these developments, focusing on the integration and benefits of multimodal strategies.[3]
Multimodal analgesia
Multimodal analgesia, which involves the concurrent use of multiple analgesic agents with different mechanisms of action, has been demonstrated to provide superior analgesic efficacy and compared to the conventional methods.[1]
Studies have shown that combining non-opioid medications (e.g., non-steroidal anti-inflammatory drugs, acetaminophen) with opioids or local anesthetics enhances pain control and reduces the need for higher doses of opioids. For instance, the combination of ibuprofen and acetaminophen has been particularly effective in managing post-operative pain in oral surgery.[2] Bupivacaine 0.5% with epinephrine 1:200,000 injected at the incision site is also deemed to be effective.[1]
Regional anesthesia
Regional anesthesia, utilizing techniques such as peripheral nerve blocks, offers localized anesthesia and analgesia, resulting in improved patient outcomes and a reduced requirement for systemic opioids. Regional anesthesia involves injecting local anesthetics near specific nerves to block sensation in a targeted area. Techniques such as inferior alveolar nerve blocks[4] and maxillary nerve blocks are commonly used in oral surgery.
Recent advancements include the use of ultrasound guidance to increase precision and efficacy. This has led to better pain control and fewer complications.[5]
ERAS protocols
The adoption of ERAS protocols in oral surgery has streamlined perioperative care, facilitated rapid recovery, and minimized the length of hospital stays.[6] ERAS protocols are designed to optimize perioperative care and improve recovery outcomes. They focus on pre-operative counseling, minimizing fasting, optimizing pain control, and early mobilization.[7]
The application of ERAS in oral surgery has been shown to reduce hospital stays and improve patient comfort. Protocols may include pre-operative carbohydrate loading and the use of non-opioid analgesics.
Minimally invasive techniques
Innovations in minimally invasive techniques, including laser-assisted surgery and piezosurgery, have significantly reduced intraoperative and post-operative tissue damage, thereby decreasing pain and accelerating the healing process. Minimally invasive techniques in oral surgery, such as piezosurgery and laser-assisted procedures, have significantly reduced tissue trauma and post-operative pain.[8]
These techniques result in less bleeding, reduced post-operative pain, and quicker recovery times. Clinical studies have demonstrated their efficacy in reducing pain and improving patient satisfaction.
PCA
The implementation of PCA has allowed for patient-specific analgesic administration, improving patient autonomy and satisfaction while optimizing pain control. PCA allows patients to administer their own pain medication within prescribed limits. This approach gives patients more control over their pain management and can reduce anxiety.[9]
Research indicates that PCA is effective in managing postoperative pain, with high levels of patient satisfaction reported. It also reduces the overall amount of medication used.[10]
Long-acting local anesthetics
The use of long-acting local anesthetics, such as liposomal bupivacaine, has extended the duration of post-operative analgesia, thereby diminishing the need for supplementary analgesic interventions. Long-acting local anesthetics, such as ropivacaine and bupivacaine, provide extended pain relief after surgery. These agents can last up to several days, significantly reducing the need for additional analgesics.[11]
Clinical trials have shown that long-acting local anesthetics are effective in managing post-operative pain, with fewer side effects compared to systemic analgesics.[3]
Non-pharmacological interventions
Non-pharmacological interventions, including cognitive-behavioral therapy, acupuncture, and relaxation techniques, are increasingly being used as adjuncts in pain management.[12]
Studies have shown that these methods can reduce pain perception and anxiety, complementing pharmacological approaches. Integrating these interventions into treatment plans can enhance overall patient care.[13]
CONCLUSION
Advances in pain management in oral surgery have led to more effective and personalized treatment options. The integration of multimodal analgesia, regional anesthesia, ERAS protocols, minimally invasive techniques, PCA, long-acting local anesthetics, and non-pharmacological interventions has significantly improved patient outcomes. Future research should continue to explore these areas to further optimize pain management strategies.
Ethical approval
Institutional Review Board approval is not required.
Declaration of patient consent
Patient’s consent not required as there are no patients in this study.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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