Postoperative Pain Management in Orthognathic Surgery: Is There a Need for Opioids?

Area of Science:

• Oral and Maxillofacial Surgery
• Pain Management
• Anesthesiology

Background:

• Orthognathic surgery traditionally involves significant pain and opioid use.
• Rising concerns about opioid-related harm necessitate re-evaluation of pain management protocols.
• This study investigates postoperative pain and analgesic needs in orthognathic surgery patients.

Purpose of the Study:

• To assess postoperative pain levels following various orthognathic surgical procedures.
• To identify factors influencing analgesic requirements.
• To determine the actual need for opioid analgesia after orthognathic surgery.

Main Methods:

• Retrospective analysis of 122 patients undergoing Le-Fort-I osteotomy, bilateral sagittal split osteotomy (BSSO), or bimaxillary surgery.
• Pain assessment using the Numeric Analog Scale (NAS) over 5 postoperative days.
• Documentation of analgesic use based on the WHO analgesic ladder.

Main Results:

• Overall mild pain levels, with a steady decline over 5 days.
• Bilateral sagittal split osteotomy (BSSO) patients reported lowest pain and required fewer non-opioid analgesics.
• Only 5.7% of patients needed opioid rescue medication, with no significant impact from gender, maxillary impaction, or mandibular advancement.

Conclusions:

• Non-opioid analgesics effectively manage pain after orthognathic surgery.
• Routine opioid prescription post-orthognathic surgery is not indicated.
• Opioid-sparing protocols ensure adequate pain control and promote safer patient recovery.