Multimodal approaches to postoperative pain management in orthognathic surgery: a comprehensive review

Effective postoperative pain management in orthognathic surgery is essential for optimizing recovery and patient comfort. This comprehensive review was performed to examine multimodal strategies for managing post-orthognathic surgery pain. A literature search identified 13 studies (with 430 patients); 11 of them were randomized controlled trials. The interventions for pain were categorized into four approaches: cooling therapies, light-based treatments, enhanced recovery protocols, and targeted techniques. A narrative synthesis was performed due to the considerable heterogeneity across the studies. Hilotherapy demonstrated superior pain and swelling reduction compared to conventional cooling methods. Light-based therapies, including low-level laser therapy and photobiomodulation, improved early postoperative pain control and functional recovery. Enhanced Recovery After Surgery (ERAS) protocols were associated with lower pain scores and opioid requirements. Targeted analgesic approaches, such as ultrasound-guided trigeminal nerve blocks and acupoint stimulation, showed promise for acute pain relief. The findings highlight the importance of combining multiple modalities to optimize pain management while minimizing opioid use. The quality of the evidence varied, with some studies limited by small sample sizes and short follow-up periods. The synthesis of results was structured into an evidence-based recommendations table, suggesting that an individualized multimodal approach may provide the most effective pain control in orthognathic surgery.