2025-02-06 ラトガース大学
<関連情報>
- https://www.rutgers.edu/news/non-opioid-pain-relievers-beat-opioids-after-dental-surgery
- https://www.sciencedirect.com/science/article/pii/S0002817724006391
第三大臼歯抜歯後の非オピオイド鎮痛薬とオピオイド鎮痛薬の比較: オピオイド鎮痛薬削減研究無作為化臨床試験 Nonopioid vs opioid analgesics after impacted third-molar extractions: The Opioid Analgesic Reduction Study randomized clinical trial
Cecile A. Feldman DMD, Janine Fredericks-Younger DMD, Paul J. Desjardins DMD, PhD, Hans Malmstrom DDS, Michael Miloro DMD, MD, Gary Warburton DDS, MD, Brent B. Ward DDS, MD, Vincent B. Ziccardi DDS, MD, Patricia Greenberg MS, Tracy Andrews MS, Pamela B. Matheson PhD, Rafael Benoliel BDS, Daniel H. Fine DMD, Shou-En Lu PhD
The Journal of the American Dental Association Available online: 4 January 2025
DOI:https://doi.org/10.1016/j.adaj.2024.10.014
Abstract
Background
Opioids are still being prescribed to manage acute postsurgical pain. Unnecessary opioid prescriptions can lead to addiction and death, as unused tablets are easily diverted.
Methods
To determine whether combination nonopioid analgesics are at least as good as opioid analgesics, a multisite, double-blind, randomized, stratified, noninferiority comparative effectiveness trial was conducted, which examined patient-centered outcomes after impacted mandibular third-molar extraction surgery. Participants were randomized to receive 5 mg of hydrocodone with 300 mg of acetaminophen (opioid) or 400 mg of ibuprofen and 500 mg of acetaminophen (nonopioid). After an initial dose, analgesic was taken every 4 through 6 hours as needed for pain.
Results
In this randomized multisite clinical trial (n = 1,815 adults), those not taking opioids experienced significantly less pain (numeric rating scale ranging from 0 [no pain] through 10 [worst pain imaginable]) for first day and night (mean difference, –0.70; 95% CI, –0.94 to –0.45; P < .001) and second day and night (mean difference, –0.28; 95% CI, –0.52 to –0.04; P = .015), and experienced no more pain than participants taking opioids over the entire postoperative period (mean difference, –0.20; 98.75% CI, –0.45 to 0.05; P = .172). Participants not taking opioids had higher overall satisfaction at the postoperative visit (85.3% extremely satisfied or satisfied vs 78.9%; 95% CI, 1.21 to 1.98; P = .006).
Conclusions
The ibuprofen and acetaminophen combination managed pain better for the first 2 days and led to greater satisfaction over the entire postoperative period than hydrocodone with acetaminophen. At no time did hydrocodone outperform the nonopioid.
Practical Implications
Routine opioid prescribing after dental surgery is not supported. The results of this study confirmed the American Dental Association’s recommendations that ibuprofen and acetaminophen in combination should be the first-line therapy for acute pain management. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT04452344.
