The critical role of maxillofacial surgeons in pain prevention and opioid consumption reduction.

OBJECTIVES: Managing pain in oral and maxillofacial surgery (OMS) poses significant challenges due to the intricate nature of the procedures and extensive tissue manipulation. While opioids are often utilized for their strong analgesic effects, they carry serious risks, including a high potential for addiction and overdose-related fatalities. This paper aims to conduct a comprehensive literature review to explore effective, opioid-sparing pain management strategies in OMS, with a specific focus on evidence-based techniques that reduce reliance on opioids.

METHODS: A comprehensive literature review was conducted using PubMed, Web of Science, and Google Scholar databases, primarily focusing on the last 5 years (2019-2024) to ensure updated information, though seminal older works were also considered. The inclusion criteria focused on studies reporting alternatives to opioids for pain and discomfort control after OMS. Narrative reviews, editorials, and articles without a digital object identifier were excluded. Relevant data from the selected articles were extracted and analyzed.

RESULTS: A total of 4,306 articles were assessed, with 102 included in the review. The procedures reviewed included orthognathic surgery, maxillofacial trauma, reconstruction, dento-alveolar surgery, temporomandibular joint procedures, cleft palate surgery, and severe odontogenic infections. Thematic analysis revealed that the central question was answered affirmatively: Nonopioid strategies are effective in reducing opioid consumption. These strategies were found to maintain post-operative pain control while minimizing complications like post-operative nausea and vomiting. This review synthesizes the evidence to provide a clear hierarchy of recommended interventions.

CONCLUSION: This review consolidates evidence indicating that a combination of stringent prescribing practices, multimodal analgesia, and regional anesthetic techniques can significantly reduce opioid dependence. To prevent opioid overprescription, it is essential to enforce strict regulatory measures, closely monitor prescriptions, establish regional guidelines, and avoid just-in-case prescribing. Effective strategies for improving post-operative outcomes and reducing opioid dependence include multimodal and pre-emptive analgesia, as well as post--operative anesthetic blocks. The findings provide a consolidated evidence base to guide maxillofacial surgeons in implementing these strategies, directly addressing the opioid crisis within the specialty.