Multimodal Patient-Controlled Analgesia in Multilevel Obstructive Sleep Apnea Surgery

Background: Multimodal analgesia involves the use of various techniques and medications to target various pain pathways and provide superior pain control, limit opioid consumption, and minimize adverse events. Objective: This study aimed to assess the efficacy and safety of a multimodal analgesic regimen combining nalbuphine and ketorolac administered via a patient-controlled analgesia (PCA) silicon device following multilevel obstructive sleep apnea (OSA) surgeries. Patients and Methods: This prospective interventional single-arm study included thirty patients who were admitted for multilevel surgery for OSA. Upon completion of the surgical procedures, fully conscious patients were connected to a disposable silicon infusion device to provide 300 ml of normal saline containing 80 mg of nalbuphine, 240 mg of ketorolac, and 8 mg of ondansetron. The infusion set provided 5 ml/h by continuous infusion without bolus doses. Postoperative pain was evaluated via the visual analogue scale (VAS) before analgesic injection and every 6 hours for 48 hours postoperatively. Results: Regarding pain intensity, the median VAS score was 2 (2-3) at baseline. It was significantly reduced to 1 (1-1) after 24 hours and 1 (0) after 48 hours (P=0.001). In terms of the level of sedation, we found that at baseline, the median Ramsay scale score was 2 (1-3), which was reduced to 1 (1-2) at 48 hours postoperatively (P=0.002). No significant adverse effects were found. Conclusions: Multimodal PCAcan provide a potent and safe option for achieving postoperative analgesia after OSA surgery.