BRITISH DENTAL JOURNAL, VOLUME 189, NO. 8, OCTOBER 28 2000 439 RESEARCH s ur gical aft e r car e anti-inflammatory drug, ibuprofen 400 mg three times a day (tds) for 5 days 4,5 was noted to be an effective analgesic regime. A single dose of ibuprofen 400 mg has been reported to provide significant pain relief in the early post-operative period after third molar surgery. 6–9 Paracetamol 500 mg combined with a centrally acting analgesic such as codeine phosphate 30 mg was also noted to be effective in pain control. 10,11 This regime is used for patients who are allergic to aspirin or are unable to take aspirin because of med- ical problems (ie ‘sensitive’ asthmatics, diabetics, patients on anti- coagulant therapy etc). The above two regimes are given in our Day Case Unit at Manchester Royal Infirmary and this article reports on the effectiveness of our prescribed regimes by evaluating patient’s satisfaction with pain relief. Method One-hundred-and-seventy-four patients undergoing routine oral surgical procedures under general anaesthesia as day cases over a 3-month period were questioned about their pain control up to 1 hour after surgery, at discharge, by telephone at 24 and at 48 hours. The patients’ age, sex, pre-operative pain, type of surgery performed, length of operation and time at which surgery ended were recorded. Pain at 1 hour post-operatively and at discharge from hospital were also noted (Fig. 1). Patients graded their response to pain at 24 and 48 hours accord- ing to the scale: 1. No pain 2. Mild pain but tolerable 3. Moderate pain but tolerated 4. Moderate pain not controlled by prescribed pain killers 5. Severe pain not controlled by additional pain killers Patients were also asked if they had taken other non-prescribed analgesics during the 48 hour post-operative recovery period. All procedures were performed by the surgeons and anaesthetists who regularly operated on day surgery lists. Peri-operative analgesia was provided by a single bolus dose of fentanyl 1μg/kg. The policy of our day unit is to prescribe ibuprofen 400 mg three times daily for all patients except those groups with allergy to aspirin or are ‘sensitive’ asthmatics when paracetamol 500 mg with codeine phosphate 30 mg two tablets six hourly were prescribed. If the prescribed analgesics were not effective, Tramadol 100 mg was available as rescue medication for patients prior to discharge from the Day Unit. Most of the staff prescribing the above regimes were not aware of this study and no attempt was made to alter surgical technique or prescribing regimes for post-operative analgesia. The pain scores were dichotomised and chi-squared tests were used to compare the differences for patients in each analgesic group. No significant differences were found, however as the numbers of patients falling into the groups were small, the power of detecting clinically important differences in pain score was low. As this find- ing had no great bearing on the conclusions of this audit, we have not presented this finding in the results’ section. Pain control after routine dento-alveolar day surgery: a patient satisfaction survey A. Joshi, 1 A. T. Snowdon, 2 J. P. Rood, 3 and H. V. Worthington, 4 Objective An audit study which examines patient’s opinions on the efficiency of two analgesic regimes prescribed to them following dento-alveolar surgery in our Day Unit. Design Single centre prospective study. Setting Oral Surgery Day Case Unit Subjects One-hundred-and-seventy-four adults undergoing routine dento-alveolar surgery under general anaesthetic were asked to assess their pain control (on a five point scale) 1 hour after surgery, at discharge from hospital and at 24 and 48 hours post-operatively. Post-operatively, patients received ibuprofen 400 mg three times daily for five days or two tablets of paracetamol 500 mg with codeine 30 mg six hourly for 5 days if they were allergic to aspirin or were asthmatics sensitive to aspirin. Patients were not given local anaesthesia intra or post- operatively. Results Completed records were obtained for 161 (93%) patients. Ibuprofen was apparently adequate in controlling pain for 147 out of 161 patients but on further questioning 42 of these patients took supplemental analgesics and self-prescribed paracetamol or a paracetamol combination. Thirteen patients who were prescribed paracetamol with codeine had adequate pain control and did not take supplemental analgesics. One patient did not require any analgesics post-operatively Conclusion Telephone contact with patients 24 and 48 hours post-surgery provides a valuable assessment of pain control following discharge from a day surgery unit. Ibuprofen offered satisfactory control of pain for 65% (95) of patients who underwent routine dento-alveolar surgery. Discharge prescriptions must be given with verbal and written instructions to ensure that patients take the correct dose and self-prescription is within safe doses. R outine dento-alveolar surgery is commonly undertaken on a day case basis. Pain, trismus and swelling are the most common complaints post-operatively. 1 A recent national survey of post- operative analgesia in day surgery units in England and Wales high- lighted that 70% of respondents feel that pain is a problem following day surgery and 90.8% of units supply their patients with analgesic drugs to take home. 2 In a review of analgesics 3 commonly used to control pain after third molar surgery, the non-steroidal 1 *Lecturer (Honorary Senior Registrar), 4 Reader in Dental Statistics, Department of Dental Medicine & Surgery, University Dental Hospital of Manchester M15 6FH; 2 Lead Nurse, Eastman Dental Institute for Oral Health Care Sciences and International Centre for Excellence in Dentistry, University of London; 3 Consultant in Oral & Maxillofacial Surgery, GKT School of Dentistry, Denmark Hill Campus, London SE5 9RW *Correspondence to: Dr A Joshi email: Ameeta.Joshi@man.ac.uk REFEREED PAPER Received 14.09.99; Accepted 24.05.00 © British Dental Journal 2000; 189: 439–442