Standard pain meds/after extractions?

[omfsj]

To all OMFS residents out there:
What are the standard meds do you guys prescribe following full/partial bony extractions in out-patient setting (i.e. no dexamethasone injection available to G.P.)?
i.e. Amox. 750 mg, q 8h, 4 days, Motrin 600mg, tid, 4 days, Diclofenac sodium 50mg, tid
Any other suggestions would be appreciated?
Does any one combine Motrin 400mg. and Tylenol #3 for patients and have them alternate them?
Thanks in advance.

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[Bifid Uvula]

To all OMFS residents out there:
What are the standard meds do you guys prescribe following full/partial bony extractions in out-patient setting (i.e. no dexamethasone injection available to G.P.)?
i.e. Amox. 750 mg, q 8h, 4 days, Motrin 600mg, tid, 4 days, Diclofenac sodium 50mg, tid
Any other suggestions would be appreciated?
Does any one combine Motrin 400mg. and Tylenol #3 for patients and have them alternate them?
Thanks in advance.

For Sedation Patients:
IM/IV combination of Toradol/Decadron prior to the procedure.
Post Op- Typically I give Vicodin and advocate use of Ibuprofen. Rarely do I give post-op antibiotics unless they are clinically indicated.

For Local Anesthesia Patients:
Typically they get Vicodin and Iburprofen.

I think Tylenol 3 sucks for post-op pain, but I have found that some patients that get post-op nausea/vomitting with Tylenol 3, do better with Vicodin or Lortab and visa-versa.

 

[Yellowman]

fentanyl patches applied over the mucosal incision works well...

 

[toofache32]

Why do you routinely give antibiotics?

 

[S Files]

Why do you routinely give antibiotics?

to screw around and increase the potential for antibiotic resistance with a future illness, and just for kicks maybe cause some stomach upset.

 

[Battlesign]

I give 4mg every 4 hours, Dilaudid.

In reality it is a crap shoot. Those that think they had a Lefort III following removal of soft tissue poppers will call in pain regardless of what you give them.

Then you will remove full bony teeth that are part of the IA, and the uppers near the orbit, and those pt. will do fine on motrin.

 

[gdsdds]

Reassurance

 

[aphistis]

fentanyl patches applied over the mucosal incision works well...

You joke, but my 110-pound wife was given Duragesic after having her thirds done. I guess this time it was the surgeon who mistook her soft tissue impactions for a LFIII.

 

[scalpel2008]

You joke, but my 110-pound wife was given Duragesic after having her thirds done. I guess this time it was the surgeon who mistook her soft tissue impactions for a LFIII.

the problem with that is that fentanyl patches take about 2 days or so for maximal effect when you first start the patch, right about the time most people don't require much narcotics anymore.

 

[Yellowman]

You joke, but my 110-pound wife was given Duragesic after having her thirds done. I guess this time it was the surgeon who mistook her soft tissue impactions for a LFIII.

Was this an oral surgeon who did the extraction, or a general dentist? fentanyl patch s/p wizzie extraction is totally ridiculous. you mean to tell me 10mg of oxycodone and 650mg of tylenol q4h wasn't enough for post-op analgesia or is your wife allergic to percocet? she could've tried adding ibuprofen on top of the percocet b4 the patch...it probably would've worked better

 

[tx oms]

For a simple extraction or two I give about 20 vicodins. For thirds I give about fourty vicodins. The patiens I see in my clinic will argue with me about pain medicine if I tell them to just take ibuprofen so I just save the time and write the Rx.

I think in private practice I will more heavily promote ibuprofen and give fewer narcs for simple extractions. If you have any competition you don't want to be known as the guy who doesn't give enough pain medicine.

Our attendings like us to give all surgical third molar patients post-op antibiotics, usually about 5 days worth.

 

[lnn2]

Vicoprofen (7.5mg hydrocodone/200mg ibuprofen), 16tabs, 1tab po q4-6h prn pain

I use that for postop ext and endo. For suspected crack heads/drug seekers, clindamycin and ibuprofen 800mg. If they keep pushing for it then Dilaudid 3mg supositories, 12supositories (6 in a box), I1SUR q6-8h prn pain. You'll need a triplicate rx.

Another similar combination is Combunox (5mg oxycodone/400mg ibuprofen). I believe it came out about few yrs ago.

 

[aphistis]

Was this an oral surgeon who did the extraction, or a general dentist? fentanyl patch s/p wizzie extraction is totally ridiculous. you mean to tell me 10mg of oxycodone and 650mg of tylenol q4h wasn't enough for post-op analgesia or is your wife allergic to percocet? she could've tried adding ibuprofen on top of the percocet b4 the patch...it probably would've worked better

Private OMS did the surgery, she's NKDA, and they didn't write any PO meds at all, just the fentanyl. I agree way overkill, but she didn't know any better. She just took what they gave her.

 

[Yellowman]

I think in private practice I will more heavily promote ibuprofen and give fewer narcs for simple extractions. If you have any competition you don't want to be known as the guy who doesn't give enough pain medicine.

Our attendings like us to give all surgical third molar patients post-op antibiotics, usually about 5 days worth.

I think a lot of people underestimate just how well ibuprofen 800mg works. I've tried it and honestly, and it's got a pretty good kick. I am a big fan of ibuprofen...I usually stay away from using it too much on elderly folks, especially the anticoagulated ones in fear of causing GI bleed, but otherwise, it's a pretty good drug.

 

[WestCoast]

I think a lot of people underestimate just how well ibuprofen 800mg works. I've tried it and honestly, and it's got a pretty good kick. I am a big fan of ibuprofen...I usually stay away from using it too much on elderly folks, especially the anticoagulated ones in fear of causing GI bleed, but otherwise, it's a pretty good drug.

i like giving narcotics. they did afterall have a surgery and a week course of vicodin isn't going to get anybody hooked. Plus, with all the side effects of ibuprofen and the renal/gi problems that NSAIDS can potentially cause, i tend to give narcotics over ibu tabs

 

[scalpel2008]

i give a narcotic prescription with just about every extraction. If I feel like they may not need it, I tell them to save their money and not get it filled unless they feel like they need to, and to take some tylenol or ibuprofen instead.. For most surgical full bony thirds, I give percocet (unless it's a wimpy pt who got nauseated with sedation, which doesn't happen much because I minimize my fentanyl use and use a lot of propofol). Unlike popular belief, most people tolerate percocet very well w/o nausea. The advantage is that if i did give them vicodin and that isn't enough, that means they have to come back in to the clinic/ED for a percocet rx. And in private practice, that means I have to go in to give them that rx. On the other hand, vicodin can be called in if they have any problems with the percocet.
If it's a pt that just comes in with an infection and gets an extraction and I+D, and I feel they will only get the narcotic filled and not the antibiotics, I write on the narcotic rx "Do no fill unless the abx rx is filled as well"

 

[Yellowman]

i like giving narcotics. they did afterall have a surgery and a week course of vicodin isn't going to get anybody hooked. Plus, with all the side effects of ibuprofen and the renal/gi problems that NSAIDS can potentially cause, i tend to give narcotics over ibu tabs

i agree...i also give narcs s/p wizzie ext. I write for perc 5/325 x 30 usually, but i tell pts to stay on scheduled ibuprofen and take percocet prn for break thru pain if conditions permit (ie: no renal/GI issues). I was just trying to make a point that ibuprofen 800mg is a very good pain med, not wimpy analgesic like many people think out there,...

 

[USAFOMS]

I give 800mg Motrin x 30, Percocet 5/325 x 20 prn pain. I have them take the first perc when they get home with a milk shake, then alternate Motrin and perc every three hours for the first 2 days. I also give 25mg Phenergan x 10 tabs. Most patients never take it, but some take nearly all. It works for Post-oper nausea from the sedation or from PO narcs