Analgesia for Oral Disease

The concept of pre-emptive analgesia is the administration of analgesics preoperatively to reduce the severity of postoperative pain. It is important to distinguish between pre-emptive analgesia and alleviation of postoperative pain. In other words, pre-emptive analgesia may block sensitization, but it does not eliminate postoperative pain; additional measures are still required to ensure a comfortable recovery. The optimum form of pain therapy is continuous pre-emptive analgesia, continuously preventing the establishment of sensitization.

The administration of opioids or local anesthetic drugs block central sensitization and nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the severity of the peripheral inflammatory response. The combined use of an opioid and an NSAID is more effective than using either drug alone. Local anesthetics (analgesics) can produce complete pain relief by blocking all sensory input from the affected area.

Basic dental analgesic plan:

• Include an opioid in the premedication.
• Use local anesthetics prior to surgery and/or administer additional opioids intraoperatively.
• Give opioids and/or NSAIDs postoperatively. Local anesthesia (administered at the end of a procedure) will also provide postoperative analgesia.
• Administer NSAIDs during recovery.