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

Orthognathic surgery is traditionally considered painful, often prompting opioid use. In the context of rising opioid-related harm, this study assessed postoperative pain levels, factors influencing analgesic requirements, and the actual need for opioids after orthognathic procedures.

A retrospective analysis of 122 patients undergoing Le-Fort-I osteotomy, bilateral sagittal split osteotomy (BSSO), or bimaxillary surgery was performed. Pain levels (Numeric Analog Scale) were recorded 3 times daily for 5 postoperative days. Analgesic use was documented according to the WHO analgesic ladder, and associations with surgical type, gender, maxillary impaction, and mandibular advancement were analyzed.

Pain levels were mild overall and declined steadily over 5 days. BSSO patients reported the lowest pain and required fewer non-opioid analgesics. Le-Fort-I and bimaxillary procedures showed higher early analgesic demand. Only 5.7% of patients required opioid rescue medication, with no corresponding increase in pain scores. Gender, maxillary impaction, and mandibular advancement showed no significant impact on analgesic requirements.

Non-opioid analgesics effectively controlled postoperative pain across procedures, and no subgroup demonstrated a consistent need for opioids.

Routine opioid prescription after orthognathic surgery seems unnecessary. Opioid-sparing protocols provide adequate pain control and support safer postoperative recovery.