Skip to main content
2026 AAOMS 108th Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Ticketed <br><i>This session/event requires a ticket.</i>
Ticketed
This session/event requires a ticket.
In-person only<br><i>This session is offered in-person only.</i>
In-person only
This session is offered in-person only.
On-demand<br><i>On-demand session available beginning Sept. 28.</i>
On-demand
On-demand session available beginning Sept. 28.
Recorded<br><i>This session will be recorded and available beginning Oct. 19</i>
Recorded
This session will be recorded and available beginning Oct. 19
Sold Out<br><i>This ticketed session/event is sold out.</i>
Sold Out
This ticketed session/event is sold out.

Dentoalveolar

OMS and Other Dental Specialists

Residents

Session: Dentoalveolar Track: Hot-off-the-Press and Abstract Session

GP1d - Exparel Reduces Opioid Use Following Third Molar Surgery: A Randomized Controlled Trial

Thursday, October 1, 2026
4:40 PM - 4:50 PM PDT

    Oral Abstract Presenter(s)

  • Karen He, DMD, MD

    Resident
    Division of Oral & Maxillofacial Surgery, University of California Los Angeles School of Dentistry
    Los Angeles, California

    • Co-Author(s)

  • MD

    Michael Delong, MD

    Professor
    University of California, Los Angeles
    Los Angeles, California

  • MJ

    Mia Joseph, DDS, MD

    Resident
    NYU Medical Center Division of Oral and Maxillofacial Surgery
    New York, New York

  • Bw

    Brent whiting, DMD

    Resident
    Division of Oral & Maxillofacial Surgery, University of California Los Angeles School of Dentistry
    Los Angeles, California

  • WO

    Wayne Ozaki, DDS, MD

    Department Chair
    Division of Oral & Maxillofacial Surgery, University of California Los Angeles School of Dentistry
    Los Angeles, California

Abstract: In 2021, over 106,000 drug overdose deaths occurred in the United States, with opioids involved in more than 75% of cases. Amid growing recognition of the link between opioid overprescribing and substance use disorders, many healthcare disciplines have shifted toward opioid-sparing pain management. Despite this trend, opioids continue to be a mainstay in pain management following third molar extractions. Studies have shown that opioid prescriptions to opioid naïve adolescents and young adults were associated with a 4.8% to 6.8% absolute risk increase of persistent opioid use.

Postoperative pain after third molar surgery typically peaks 24 to 48 hours after the procedure, well beyond the duration of standard local anesthetics. Liposomal bupivacaine is a long-acting local anesthetic designed to extend analgesia up to 72 hours. The purpose of this study was to evaluate whether adding liposomal bupivacaine to standard local anesthesia reduces postoperative opioid use and pain following third molar extractions.

This randomized, single-blind trial was conducted in an outpatient oral surgery practice in Los Angeles, CA. ASA I-II patients undergoing extraction of 4 impacted third molars under intravenous sedation were eligible. Participants were randomized to receive either standard local anesthesia (lidocaine and bupivacaine) or standard local anesthesia plus liposomal bupivacaine (10 mL/133 mg infiltrated at least 20 minutes after lidocaine). All patients received the same postoperative instructions: around the clock naproxen and acetaminophen along with oxycodone 5 mg (20 tablets) prescribed for breakthrough severe pain. Patients recorded daily pain scores using the Wong-Baker FACES scale and documented medication use through postoperative day 5.

The study included 93 patients (47 control, 46 liposomal bupivacaine) treated between January 2023 and June 2025. The primary outcomes were any opioid use and cumulative opioid consumption through postoperative day 5 (reported as morphine milligram equivalents, MME). Data were patient-reported via a written survey which was collected at their first postoperative appointment. Any opioid use was compared using χ2 testing, cumulative MME using the Mann-Whitney U test, and pain scores using a linear mixed-effects model (α = 0.05).

The proportion of patients who used any opioids was significantly lower in the liposomal bupivacaine group (26% vs 53%, P = .022). Mean cumulative opioid consumption was also lower (5.7 vs 12.4 MME, P = .015). Pain scores decreased over time in both groups, with no significant difference between groups (P = .3).

Liposomal bupivacaine represents a promising addition to multimodal pain management for third molar surgery, particularly for adolescents and young adults at elevated risk for prolonged opioid use. The reduction in opioid consumption observed in this study was both statistically and clinically meaningful, despite similar pain scores between groups.



References

1. Schroeder AR, Dehghan M, Newman TB, Bentley JP, Park KT. Association of Opioid Prescriptions From Dental Clinicians for US Adolescents and Young Adults With Subsequent Opioid Use and Abuse. JAMA Intern Med. 2019;179(2):145-152. doi:10.1001/jamainternmed.2018.5419

2. Harbaugh CM, Lee JS, Hu HM, et al. Persistent Opioid Use Among Pediatric Patients After Surgery. Pediatrics. 2018;141(1):e20172439. doi:10.1542/peds.2017-2439