Anesthesiologist preference for postoperative analgesia in major surgery patients with obstructive sleep apnea

Abstract

Obstructive sleep apnea (OSA) is prevalent and presents perioperative challenges. There are guidelines regarding perioperative care of OSA, but analgesia management of OSA patients is inconsistent or inadequate. This is a study of the United Kingdom anesthesiologists' postoperative analgesia preferences for OSA patients. Overall, the 1st choice of main analgesia was continuous epidural local anesthetic (LA) without opioid, at 30% rate; P = 0.001. The 2nd choice was continuous epidural LA plus fentanyl, at 21% rate; P = 0.001. The 3rd choice was intrathecal diamorphine, at 19% rate; P = 0.001. The 4th choice was nerve block catheter LA infusion, at 13% rate; P = 0.001. The 5th choice was wound infiltration with LA ± epinephrine, at 8% rate; P = 0.001. The 6th choice was systemic opioid, at 7% rate; P = 0.007. The 7th choice was systemic nonsteroidal anti-inflammatory drugs, at 2% rate; P = 0.001. The hospital setting or anesthesiologists' experience did not significantly impact analgesia choice: P =0.411. This study shows that current practice by anesthesiologists has a preference for regional or opioid-sparing analgesia for OSA patients. This safe approach conforms to guidelines and should be encouraged.

Keywords

• Obstructive sleep apnea; opioid-sparing analgesia; perioperative guidelines; postoperative analgesia; regional analgesia