Background. The role of perioperative pain management is not only to reduce acute postoperative pain (POP) but also to prevent chronic POP. It would be important to know the usefulness of nerve blockade for perioperative management. However, it has not been extensively studied in orofacial surgery. The objective of the study was to investigate whether perioperative nerve blockade reduces acute POP after orthognathic surgery. Methods. Patients scheduled for orthognathic surgery were retrospectively reviewed (“preblock group”: the nerve blockade was performed before emergence from general anesthesia, and “no preblock group”: the nerve blockade was not performed before emergence from general anesthesia). The visual analog scale (VAS; 0–100 mm)-POP intensity, the VAS-POP areas under the curves (VASAUCs (mm × day)) in addition to VASAUCs for postoperative hours 6 (VASAUC_6), 12 (VASAUC_12), 18 (VASAUC_18), and 24 (VASAUC_24), the analgesic requirement period (day), and the number of days with pain (day) were analyzed. Data are presented as median (interquartile range) values. Results. Fifty-six patients (preblock group, 22; no preblock group, 34) were included (21 males, 35 females; age: 22.0 [21.0–28.0] years). VASAUC_6, VASAUC_12, VASAUC_18, and VASAUC_24 in the preblock group were significantly smaller than those in the no preblock group (3.5 [2.0–7.2] vs. 7.4 [5.1–10.0], p  = 0.0007; 9.5 [6.4–13.7] vs. 15.0 [7.2–22.9], p  = 0.042; 15.7 [10.3–23.1] vs. 29.3 [18.9–37.2], p  = 0.0002; and 17.6 [12.7–27.2] vs. 39.5 [22.9–46.9], p  = 0.001, respectively). There were no significant differences between the 2 groups in VASAUC, the analgesic requirement period, and the number of days with pain ( p  > 0.05). Conclusions. Perioperative nerve blockade reduces POP after orthognathic surgery, especially for the acute postoperative period.