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

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 1(st) choice of main analgesia was continuous epidural local anesthetic (LA) without opioid, at 30% rate; P = 0.001. The 2(nd) choice was continuous epidural LA plus fentanyl, at 21% rate; P = 0.001. The 3(rd) choice was intrathecal diamorphine, at 19% rate; P = 0.001. The 4(th) choice was nerve block catheter LA infusion, at 13% rate; P = 0.001. The 5(th) choice was wound infiltration with LA ± epinephrine, at 8% rate; P = 0.001. The 6(th) choice was systemic opioid, at 7% rate; P = 0.007. The 7(th) 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.