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Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science

Advisor

Mac Machan, MD; Ashlyn Call, MPAS, PA-C; Ross Ahrendes, BS, CNIM

Abstract

Patients undergo dermatologic surgery for a variety of reasons. Cases may be minor excisions with simple repair or extensive Mohs micrographic surgery (MMS) requiring involved flap reconstruction. Many patients develop some level of postoperative pain (POP) requiring oral analgesia and traditional methods of pain control include oral acetaminophen (Ac), or an opioid such as Ac + codeine. Opioids are associated with unpleasant adverse events such as nausea, pruritus, constipation, altered mental status, and potential for addiction, thus requiring judicious use. Alternatively, ibuprofen (Ibu), a non-steroidal anti-inflammatory (NSAID), has a proven efficacy and tolerability profile, but its use is often discouraged by dermatologic clinicians for fear of increased bleeding during, and hematoma formation after surgery. Evidence demonstrates, however, that there is no clinically significant increases in bleeding time, ecchymosis, or other postoperative adverse events when Ibu is administered during the perioperative period. Current dermatology guidelines recommend Ibu as a first-line postoperative analgesic. Despite these guidelines and current evidence, Ibu is rarely recommended for pain control, or actively discouraged. Given the need for prudent opiate use and effective pain control, Ibu alone or in combination with Ac can offer superior analgesia, fewer adverse events, and greater patient satisfaction.

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