Bamgbade Olumuyiwa A
Department of Anaesthesia, University of British Columbia, Vancouver, Canada.
Saudi J Anaesth. 2018 Jul-Sep;12(3):475-477. doi: 10.4103/sja.SJA_25_18.
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 choice of main analgesia was continuous epidural local anesthetic (LA) without opioid, at 30% rate; = 0.001. The 2 choice was continuous epidural LA plus fentanyl, at 21% rate; = 0.001. The 3 choice was intrathecal diamorphine, at 19% rate; = 0.001. The 4 choice was nerve block catheter LA infusion, at 13% rate; = 0.001. The 5 choice was wound infiltration with LA ± epinephrine, at 8% rate; = 0.001. The 6 choice was systemic opioid, at 7% rate; = 0.007. The 7 choice was systemic nonsteroidal anti-inflammatory drugs, at 2% rate; = 0.001. The hospital setting or anesthesiologists' experience did not significantly impact analgesia choice: =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.
阻塞性睡眠呼吸暂停（OSA）很常见，并且在围手术期会带来挑战。关于OSA围手术期护理有相关指南，但OSA患者的镇痛管理并不一致或不充分。这是一项关于英国麻醉医生对OSA患者术后镇痛偏好的研究。总体而言，主要镇痛方法的首选是不使用阿片类药物的持续硬膜外局部麻醉（LA），占比30%；P = 0.001。第二选择是持续硬膜外LA加芬太尼，占比21%；P = 0.001。第三选择是鞘内注射二醋吗啡，占比19%；P = 0.001。第四选择是神经阻滞导管LA输注，占比13%；P = 0.001。第五选择是用LA±肾上腺素进行伤口浸润，占比8%；P = 0.001。第六选择是全身性阿片类药物，占比7%；P = 0.007。第七选择是全身性非甾体抗炎药，占比2%；P = 0.001。医院环境或麻醉医生的经验对镇痛选择没有显著影响：P = 0.411。这项研究表明，麻醉医生目前的做法倾向于对OSA患者采用区域镇痛或阿片类药物节省镇痛。这种安全的方法符合指南，应该得到鼓励。
