Pain management at MediLavia clinic

We offer every type of sedation — from nitrous oxide, 'laughing gas', to comfortable medicated sleep under the control of experienced anaesthesiologists: total intravenous anaesthesia and combined endotracheal anaesthesia.

We do not treat by template. For every patient — whether a child with dentophobia, a pregnant woman or an elderly person with chronic conditions — we select an individual analgesia protocol.

1. •

   For children

   We use a sensory-adapted environment and comfort positions. More — pain management in children

2. •

   For expectant mothers

   Safe medications that do not affect the baby's health.

3. •

   For the elderly

   Careful dosing that takes kidney and heart condition into account.

Instead of a single strong drug we use a combination of several mild methods. This makes it possible to switch pain off completely while cutting the risk of side effects by 70 per cent.

We use long-acting regional blocks. This means you will feel no pain not only during the procedure but for many hours afterwards.

1. •

   NSAIDs are first-line therapy, not opioids

   High- and moderate-certainty evidence (82 RCTs) shows that NSAIDs — ibuprofen, naproxen — alone or combined with paracetamol outperform opioids in relieving acute dental, ENT and maxillofacial pain. A combination of ibuprofen 200–400 mg and 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]}

2. •

   Multimodal analgesia is the standard of perioperative pain relief

   The optimal protocol includes paracetamol, an NSAID or COX-2 inhibitor, dexamethasone and regional or local anaesthesia, with opioids reserved only for breakthrough pain. In maxillofacial surgery a pilot study showed that a multimodal opioid-free protocol — paracetamol, celecoxib and pregabalin before surgery; ketorolac, ibuprofen and gabapentin afterwards — reduces opioid consumption by 70 per cent without worsening pain control. ^{[5, 6, 7]}

3. •

   Intraoperative dexamethasone improves pain relief

   Intravenous dexamethasone during surgery is associated with reduced pain in the first 24 hours after third-molar surgery (n = 1774). The 'non-opioid analgesic plus dexamethasone' group showed the lowest pain scores among all comparison groups. Corticosteroids also reduce trismus and swelling. ^[8]

4. •

   Local and regional anaesthesia is a mandatory component

   Infiltration or a block with a long-acting local anaesthetic — bupivacaine — before discharge provides prolonged analgesia and complements, but does not replace, systemic analgesia. Regional blocks are effective in both dentistry and ENT surgery. ^{[1][9, 10, 11]}

5. •

   Opioids only when first-line therapy fails

   Opioids are prescribed solely when non-opioid agents provide inadequate pain control, as a short course of 1–2 days, with mandatory informed patient consent regarding the risks of dependence, respiratory depression and side effects. The 'just-in-case' prescription practice is not recommended. ^[1][3]

6. •

   The principle of the minimum effective dose

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

7. •

   Many ENT operations need no opioids

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

8. •

   Shared decision-making and realistic expectations

   The clinician discusses the analgesia plan with the patient and explains that some pain should be expected and that analgesics should make it manageable.

1. •

   Dentistry

   From treating caries to complex implantation — all protected by a personal analgesia protocol.

2. •

   ENT surgery

   Unique protocols after tonsillectomy and septoplasty that let you return to normal life as soon as the next day.

3. •

   Paediatrics

   The Pain Team — paediatrician, anaesthesiologist and psychologist — does everything so the child does not even notice the medical procedures. More — the pain management concept

4. •

   Maxillofacial surgery

   High-tech operations using intraoperative dexamethasone to minimise swelling and discomfort.