There is limited evidence on the effects and safety of postoperative analgesic techniques in patients with obstructive sleep apnoea (OSA); most recommendations are based on expert opinion or consensus.

A major concern in treatment of these patients is use of opioid analgesics and their potential to increase the number and aggravate severity of obstructive episodes leading to worse desaturation. Another issue, is the intensity of monitoring and the use of continuous positive airway pressure (CPAP) postoperatively and thereby, the environment (high dependency unit, intensive care unit) that patients with obstructive sleep apnoea are best cared for in. ANZCA chapter 11.5 p 411.

Condition specific preoperative analgesic issues

Multimodal analgesic strategies (in particular relying on non-opioid analgesics and regional techniques) aiming towards opioid-sparing (or ideally avoiding opioids) should be used in patients with OSA. ANZCA chapter 11.5 page 413.

The use of continuous positive airway pressure (CPAP) is recommended to reduce risk of hypoxaemic episodes; it does not increase the incidence of anastomotic leakage, even after upper gastrointestinal surgery. ANZCA chapter 11.5 page 413.

Use of supplemental oxygen is recommended to reduce the risk of severe hypoxaemia.

Condition specific issues related to nursing / monitoring patients

Monitoring and supervision in a high dependency or intensive care environment may reduce risks for patients with OSA.

A setting that permits continuous pulse oximetry should be preferred.

Patients should be placed in non-supine positions if possible. ANZCA chapter 11.5 page 413.

Summary

Patients with OSA may be at increased risk of obstructive episodes and de-saturation. Management strategies that may increase efficacy and safety of pain relief in these patients include appropriate multimodal, non-opioid analgesia, continuous positive airway pressure, monitoring and supervision and supplemental oxygen.

Supplementary reading

1. Gross JB, Bachenberg KL, Benumof JL et al (2006) Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology 104(5): 1081–93. http://journals.lww.com/anesthesiology/Citation/2006/05000/Practice_Guidelines_for_the_Perioperative.26.aspx