Personalized Prescribing Sharply Cut Leftover Opioid After Orthognathic Surgery

Edited by Dentaltown staff

Tailoring postoperative opioid prescriptions to each patient’s inpatient use, paired with an individualized tapering schedule, left far less unused medication after orthognathic surgery than standard fixed-dose prescribing, according to a randomized trial published Aug. 10 in the Journal of Oral and Maxillofacial Surgery.

Investigators at Dalhousie University in Halifax, Nova Scotia, randomized adults undergoing single- or double-jaw orthognathic surgery between April 2023 and April 2024 to either a standardized opioid prescription or a personalized prescription based on inpatient opioid consumption with individualized tapering. The primary outcome was unused hydromorphone at two weeks.

The difference was large. After single-jaw surgery, median unused hydromorphone was 4 mg in the personalized group compared with 36.5 mg under the standard protocol. After double-jaw surgery, the figures were 4 mg and 29 mg. Both comparisons reached P less than .001.

Actual consumption also fell, from a median of 7 mg under standard prescribing to 1 mg under the personalized protocol, at P = .01.

Pain control did not suffer. Pain scores were similar between groups at P = .7. Satisfaction was comparable in the single-jaw cohort and higher in the personalized group after double-jaw surgery, at P = .004.

After adjustment for covariates including age, sex, body mass index, psychiatric history, substance use, surgical plan, and operative duration, opioid surplus was associated with personalized protocol assignment at an incidence rate ratio of 0.19, and with female sex at 0.71.

The authors concluded that personalized prescribing reduced absolute postoperative opioid surplus without compromising pain control or satisfaction.

Amr Alsabbagh, Matthew Kelvey, Kara Matheson, Benjamin Davis, M. Kwesi Kwofie, and Jean-Charles Doucet conducted the trial, published open access.

Of 201 patients enrolled, 151 completed the study, an attrition rate of 25%. The trial ran at a single center, and leftover medication counts depend on patient reporting. Mean age was 31.4 years and 63% of participants were female.

Sources:
Journal of Oral and Maxillofacial Surgery, “Personalized opioid prescribing with an individualized tapering protocol following orthognathic surgery reduces the amount of unused opioid,” published online Aug. 10, 2026: sciencedirect.com/science/article/pii/S0278239126008402
DOI: doi.org/10.1016/j.joms.2026.07.030