Li Cheng-Wei, Hsu Yueh-Hsien, Tsao Chien-Han
Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung City, 40201, Taiwan.
Department of Otolaryngology, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo N. Rd., South District, Taichung City, 40201, Taiwan.
J Robot Surg. 2025 Sep 26;19(1):636. doi: 10.1007/s11701-025-02829-w.
Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a chronic disorder with significant comorbidities. Transoral robotic surgery (TORS) combined with uvulopalatopharyngoplasty (UPPP) is an established treatment, but postoperative pain management remains challenging. This study evaluates the efficacy of dinalbuphine sebacate (DNS), an extended-release analgesic, in reducing opioid use and managing postoperative pain in TORS UPPP patients. This retrospective cohort included consecutive TORS-UPPP patients from 1 January 2020 to 30 June 2024; the database was locked on 30 June 2024 prior to analysis. The patients were divided into a DNS group (n = 96) and a conventional analgesia (CA) group (n = 42). The DNS group received a 150 mg intramuscular injection after anesthetic induction and after the surgery. Analgesic consumption, opioid usage, and pain scores were evaluated from the day of surgery (POD0) to two days postoperatively (POD2), as well as opioid prescriptions at discharge and during the first follow-up. The DNS group exhibited a significantly lower percentage of opioid use during POD0-POD2 (30.21% vs. 54.76%, p < 0.001) and a reduced oral morphine equivalent dose (15.31 ± 36.68 mg vs. 56.79 ± 85.83 mg, p = 0.001). Opioid prescriptions at discharge (68.75% vs. 88.10%, p = 0.016) and at the first follow-up (13.54% vs. 52.38%, p < 0.001) were also lower in the DNS group, with comparable analgesic effects. DNS effectively reduces postoperative opioid consumption and prescription in TORS UPPP patients without significant adverse effects. These findings support the integration of DNS into multimodal analgesia protocols for OSAHS surgery, substantially reduced inpatient and post-discharge opioid use (NNT ≈ 3-5) with small, likely non-clinically important differences in pain scores and no significant safety signal, supporting its clinical relevance in OSAHS surgical programs. Warranting further multicenter validation.
阻塞性睡眠呼吸暂停低通气综合征（OSAHS）是一种伴有严重合并症的慢性疾病。经口机器人手术（TORS）联合悬雍垂腭咽成形术（UPPP）是一种既定的治疗方法，但术后疼痛管理仍然具有挑战性。本研究评估了长效镇痛药丁丙诺啡癸酸酯（DNS）在减少TORS UPPP患者阿片类药物使用和管理术后疼痛方面的疗效。这项回顾性队列研究纳入了2020年1月1日至2024年6月30日连续的TORS-UPPP患者；在分析前，数据库于2024年6月30日锁定。患者被分为DNS组（n = 96）和传统镇痛（CA）组（n = 42）。DNS组在麻醉诱导后和手术后接受150 mg肌肉注射。从手术当天（术后第0天）到术后两天（术后第2天）评估镇痛药物消耗、阿片类药物使用情况和疼痛评分，以及出院时和首次随访时的阿片类药物处方。DNS组在术后第0天至第2天阿片类药物使用百分比显著较低（30.21%对54.76%，p < 0.001），口服吗啡等效剂量减少（15.31±36.68 mg对56.79±85.83 mg，p = 0.001）。DNS组出院时（68.75%对88.10%，p = 0.016）和首次随访时（13.54%对52.38%，p < 0.001）的阿片类药物处方也较低，镇痛效果相当。DNS可有效减少TORS UPPP患者术后阿片类药物的消耗和处方，且无明显不良反应。这些发现支持将DNS纳入OSAHS手术的多模式镇痛方案，显著减少住院期间和出院后阿片类药物的使用（NNT≈3 - 5），疼痛评分差异小且可能无临床重要意义，也无明显安全信号，支持其在OSAHS手术方案中的临床相关性。值得进一步进行多中心验证。
