A patient with chronic hepatitis B and a history of opioid abuse requires postoperative pain management after a dental extraction. Which analgesic regimen is most appropriate?

In a patient with hepatitis B (liver disease) and a history of opioid abuse, the safest analgesic approach is multimodal non-opioid therapy: alternating or combining acetaminophen (at reduced doses due to hepatic involvement — max 2g/day in liver disease) with ibuprofen (an NSAID). This combination provides synergistic analgesia comparable to opioids for dental pain. Opioid-containing combinations (hydrocodone, oxycodone) are contraindicated given the history of opioid abuse. Tramadol has opioid-like properties and abuse potential, making it inappropriate. NSAIDs should be used cautiously if renal function is also compromised.