Postsurgical Pain Management After Third-Molar Extraction

Objectives: Reducing opioid prescriptions after third-molar extraction (M3) may decrease opioid-related adverse events and the risk of opioid dependence in this population. Liposomal bupivacaine (LB; EXPAREL^®) is approved in the United States for single-dose infiltration in adults to produce long-lasting postsurgical analgesia. This retrospective chart review compared clinical outcomes, including opioid-prescribing patterns, in patients who did or did not receive LB infiltration immediately after extraction.
Methods: Deidentified data from patients (N=600) from 2 oral surgery centers in the United States were extracted from electronic medical records. Consecutive records from patients aged ≥18 years undergoing elective M3 in an outpatient venue (with ≥1 partial bony- or full bony–impacted tooth in the mandible) who either received or did not receive LB between 2012 and 2018 were included. Perioperative protocols were similar in both groups, except for LB administration. Procedure characteristics, patient demographics, presurgical clinical characteristics, outcomes (eg, opioid prescriptions, refills), and complications were compared across groups using descriptive statistics. A t test was used for comparison of number of opioids prescribed.
Results: Three hundred patients (50%) received LB. Among all patients, 57% were female. There were no differences in baseline characteristics between groups. No patient received opioids before extraction, and 99% received a postsurgery opioid prescription. Mean (standard deviation) number of opioids prescribed to patients (including refills) was 6.4 (3.2) pills (LB group), versus 15.5 (6.3) pills (non-LB group; P<0.001), corresponding to 46.8 versus 130.3 morphine-equivalent mg. Four (1.3%) patients (LB group) experienced dry socket, compared with 18 patients (6.0%; non-LB group). There were fewer additional opioid prescriptions in the LB group (3.3%) versus the non-LB group (7.7%).
Conclusions: Patients undergoing elective M3 and receiving LB were prescribed significantly fewer opioids than non-LB patients with less additional prescriptions. Long-lasting LB provided an opportunity to significantly reduce opioid use for postsurgical analgesia.