Introduction: 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. Methods: 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. Results: 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. Discussion: Non-opioid analgesics effectively controlled postoperative pain across procedures, and no subgroup demonstrated a consistent need for opioids. Conclusions: Routine opioid prescription after orthognathic surgery seems unnecessary. Opioid-sparing protocols provide adequate pain control and support safer postoperative recovery.
Stoll et al. (Mon,) studied this question.