Personalized Opioid Prescribing With an Individualized Tapering Protocol Following Orthognathic Surgery Reduces the Amount of Unused Opioid.

Summary

In this prospective randomized trial, 201 adults undergoing single- or double-jaw orthognathic surgery were assigned to standardized opioid prescribing or personalized prescribing based on inpatient use with individualized tapering. Among 151 completers, median unused hydromorphone was 4.0 mg with personalized prescribing versus 29.0-36.5 mg with standard prescribing, while pain scores remained similar.

Key Findings

• The study enrolled 201 patients, with 151 completing the 2-week assessment.
• Median unused hydromorphone was 4.0 mg with personalized prescribing versus 36.5 mg after single-jaw surgery and 29.0 mg after double-jaw surgery with standard prescribing.
• Personalized prescribing reduced postoperative hydromorphone consumption without worsening pain; satisfaction was higher after double-jaw surgery.

Clinical Implications

Postoperative opioid prescriptions can be based on actual inpatient opioid requirements followed by an individualized taper rather than a fixed dose. This approach may reduce unused medication while maintaining patient comfort, but local validation and reliable follow-up are needed before broad implementation.

Limitations

• There was 25% attrition, which may introduce attrition bias.
• The single-center design and orthognathic surgery population may limit generalizability.
• The study did not establish whether the intervention reduces long-term opioid exposure or diversion.

Future Directions

Multicenter pragmatic trials should test individualized prescribing across different surgical populations and evaluate long-term opioid use, medication disposal, patient-reported outcomes, and implementation costs.