Poorly Controlled Postoperative Pain Following Mandibular Third Molar Surgery: A Prospective Observational Study

Objectives: Poorly controlled postoperative pain (PPP) remains a persistent challenge following mandibular third molar (MTM) surgery. This study aimed to identify the incidence and associated prognostic factors of PPP occurring within 1 week following MTM surgery. Materials and Methods: This prospective observational study was conducted on 307 MTM surgeries, from which perioperative variables were obtained. Pain intensity at rest and during movement was obtained over 7 days following surgery. The pain descriptors, pain locations, and pattern of rescue analgesic use were also recorded. The primary outcome was the cumulative incidence of PPP. Statistical Analysis: Multivariable generalized linear models with robust standard errors clustered at the patient level identified independent predictors of PPP. Temporal pain intensity changes were analyzed using multilevel linear mixed-effects modeling, and pain variability was assessed via intraindividual standard deviation. Time to pain resolution and rescue analgesic cessation were compared using Kaplan-Meier estimation and log-rank tests. Results: Of the 307 MTM surgeries included, 47 cases (15.31%) developed PPP. Operative time longer than 60 minutes (aOR = 3.95, 95% CI: 1.29 to 12.03) was significantly associated with PPP. The greatest pain intensity was noted at 6 hours postoperatively, with 20% pain reduction at 12 hours. Tender, throbbing, and aching pain were commonly reported within the first 24 hours. Body-angle region was the most affected location, and almost 20% of the patients reported widespread pain within 48 hours postoperatively. Only 44.63% of patients achieved pain resolution within 1 week. The median time to rescue analgesic cessation was 4 days. Conclusion: PPP remains prevalent following MTM surgery and exhibits distinct pain patterns that warrant specifically tailored pain management. Prolonged operative duration, likely reflecting greater cumulative surgical trauma, is an independent prognostic factor and should be recognized for early identification of high-risk patients.