Pain management in adults: how MediLavia keeps treatment pain-free

At MediLavia we have changed the very idea of a visit to the doctor. Dentistry, ENT surgery, maxillofacial surgery and pediatrics are no longer associated with fear. We have created a unique pain management system based on international safety standards and deep respect for every patient’s comfort.

Why is it not painful at MediLavia?

We offer all types of sedation — from nitrous oxide (“laughing gas”) to comfortable medication-induced sleep under the supervision of experienced anesthesiologists (total intravenous anesthesia, combined endotracheal anesthesia).

In addition, we use

1. A personal “Pain Code” for everyone

We do not treat by template. For each patient — whether a child with dental anxiety, a pregnant woman or an older person with chronic conditions — we choose an individual pain relief protocol.

• For children — we use a sensory-adapted environment and “comfort positions” (see Pain management in children)
• For expectant mothers — safe medicines that do not affect the baby’s health
• For older people — careful choice of doses, taking kidney and heart function into account

2. A multimodal approach: 1+1=0 pain

Instead of one strong drug, we use a combination of several gentle methods. This makes it possible to “switch off” pain completely while reducing the risk of side effects by 70%.

3. We use long-acting regional blocks. This means you will not feel pain not only during the procedure but also for many hours afterwards.

4. We follow these principles of evidence-based anesthesiology in dentistry, maxillofacial surgery and ENT practice:

4.1. NSAIDs, not opioids, are the first line of therapy

High- and moderate-certainty evidence (82 RCTs) shows that NSAIDs (ibuprofen, naproxen) alone or in combination with paracetamol are more effective than opioids for acute dental, ENT and maxillofacial pain. The combination of ibuprofen 200–400 mg + paracetamol 500–1000 mg provides the greatest analgesic effect. The guidelines of the American Dental Association (ADA, 2024) and the American Academy of Otolaryngology (AAO-HNS, 2021) unanimously recommend non-opioid analgesics as first-line therapy. ^[1][2][3][4]

4.2. Multimodal analgesia is the standard of perioperative pain relief

The optimal multimodal protocol includes paracetamol + an NSAID (or a COX-2 inhibitor) + dexamethasone + regional/local anesthesia, with opioids reserved only for breakthrough pain. In maxillofacial surgery, a pilot study showed that a multimodal opioid-free protocol (paracetamol + celecoxib + pregabalin before surgery; ketorolac + ibuprofen + gabapentin after surgery) reduces opioid use by 70% without worsening pain control. ^[5][6][7]

4.3. Intraoperative dexamethasone improves postoperative pain relief

Intravenous dexamethasone during surgery is associated with less pain in the first 24 hours after third molar surgery (n = 1774). The “non-opioid analgesic + dexamethasone” group had the lowest pain scores of all the groups compared. Corticosteroids also reduce trismus and swelling. ^[8]

4.4. Local and regional anesthesia is a mandatory component

Infiltration or a block with a long-acting local anesthetic (bupivacaine) before the patient goes home provides prolonged pain relief and complements, but does not replace, systemic analgesia. Regional blocks (infraorbital, mental, inferior alveolar nerve and others) are effective in both dentistry and ENT surgery. ^{[1][9][10][11]}

4.5. Opioids only when first-line treatment fails, for the shortest time

Opioids are prescribed only when pain is not adequately controlled with non-opioid medicines, as a short course (1–2 days), and always with the patient’s informed consent about the risks of dependence, respiratory depression and side effects. The practice of a “just-in-case” prescription is not recommended. ^[1][3]

4.6. The minimum effective dose principle

All analgesics are prescribed at the minimum effective dose. Maximum daily doses: ibuprofen — 2400 mg, naproxen sodium — 1100 mg, paracetamol — 4000 mg. When combination products (paracetamol + opioid) are prescribed, the total dose of paracetamol must be monitored. ^[1]

4.7. Many ENT operations need few or no opioids

Studies show limited or no need for opioids after thyroidectomy/parathyroidectomy, endoscopic sinus surgery and septoplasty/rhinoplasty. Patients on opioid-free protocols report high satisfaction with pain control. ^[3]

4.8. Shared decision-making and realistic expectations

The clinician must discuss the pain relief plan with the patient and explain that “some pain should be expected, and analgesics should make it manageable”.

Our specialties

• Dentistry — from treating caries to complex implant surgery — all protected by a personal analgesia protocol
• ENT surgery — unique protocols after tonsillectomy and septoplasty that let you return to your usual life the very next day
• Pediatrics — the “Pain Team” (pediatrician + anesthesiologist + psychologist) does everything so that the child does not even notice the medical procedures (see MediLavia’s pain management concept)
• Maxillofacial surgery — high-tech operations using intraoperative dexamethasone to minimize swelling and discomfort