TABLE IX.B.4.

Pain management after sleep surgery

Study	Year	LOE	Study design	Study groups	Clinical endpoint	Conclusion
Diakos et al.1577	2011	1a	SR	RCTs (n = 580) with adults undergoing tonsillectomy where peri-operative steroids were used	Pain level compared dexamethasone use with control or placebo	Dexamethasone significantly reduced pain and postoperative nausea and vomiting in adults undergoing tonsillectomy.
Mason et al.1425	2015	1a	SR	RCTs (n = 293) with adult OSA patients where participants were randomly assigned to use opiates or opioids, sedatives, hypnotics, or placebo	Effect on OSA severity	No evidence suggests that the pharmacological compounds assessed have a deleterious effect on the severity of OSA as measured by change in AHI or ODI. Significant clinical and statistical decreases in minimum overnight SpO2 were observed with remifentanil, zolpidem 20 mg and triazolam 0.25 mg.
Tolska et al.1583	2019	1a	SR	RCTs (n = 1816) reporting on analgesics and dexamethasone for post-tonsillectomy pain in adults and adolescents (>13 years)	Pain intensity	Paracetamol, gabapentinoids, and dexamethasone reduced pain on the day of surgery. Ketoprofen, ibuprofen, indomethacin, lornoxicam, parecoxib, rofecoxib, and dextromethorphan reduced pain intensity, need for rescue analgesics, or both on the day of surgery. Dexamethasone in multiple doses provided analgesia beyond the first postoperative day.
Titirungruang et al.1578	2019	1a	SR	RCTs (n = 6327) of steroids in adults and children who underwent tonsillectomy	Pain, nausea/vomiting, hemorrhage outcomes	IV steroids significantly decreased immediate postoperative pain severity, as well as nausea/vomiting.
Yang et al.1569	2015	1b	RCT	OSA patients (n = 260, 65 in each group) who underwent H-UPPP 1. Intranasal butorphanol 2. Intravenous butorphanol 3. Intranasal fentanyl 4. Intravenous saline (control)	Postoperative day 1, 6, 12, 18, 24, 36, 48 – hour pain scores: VAS and Brureggemann comfort scale Cognitive dysfunction evaluated by Mini-Mental Status Examination assessed 1 day before, and 1, 3, and 7 days postoperatively	Intranasal administration of butorphanol is safe and effective, reducing postoperative usage of analgesic and the incidence of postoperative cognitive dysfunction in patients undergoing H-UPPP.
Huang et al.1549	2009	1b	RCT	OSA patients (n = 12) who underwent UPPP 1. Transasal butorphanol (n = 7) 2. Oral mefenamic acid and intramuscular meperidine (n = 5)	Pain scores at 12, 24, 72-h postoperatively VAS Clinical Global Impression in Severity and Improvement Postoperative pain-related morbitidies (PRM) and quality of life in bodily pain (QOL-BP) were evaluated 72-h postoperatively	Transnasal butorphanol can safely alleviate wound pain after UPPP. No significant difference in degree of pain relief was found between the two groups.
Lee et al.1570	2007	1b	RCT	Patients who underwent surgical OSA treatments (n = 90, 45 in each group) 1. Intravenous ketorolac 2. Oral mefenamic acid and intramuscular meperidine	Postoperative discomfort by self-assessment questionnaire on 1st and 3rd days after surgery Patient satisfaction with postoperative pain treatment evaluated at 1 month postoperatively	Short-term administration of intravenous ketorolac is noninferior to the conventional regimen and represents a safe treatment for wound pain after OSA surgery.
Xie et al.1572	2013	1b	RCT	UPPP patients (n = 40, 20 in each group) randomized to two groups 1. local block with ropivacaine + saline 2. local block with ropivacaine + intra- and postoperative parecoxib infusion	VAS pain score at 24 and 48 h after surgery; postoperative adverse effects	Intravenous parecoxib combined with incision-local ropivacaine provided effective postoperative analgesia.
Li et al.1571	2014	1b	RCT	UPPP patients (n = 50, 25 in each group) randomized to 2 groups 1. submucosal infiltration of ropivacaine + epinephrine 2. submucosal infiltration of saline + epinephrine	Cumulative patient-controlled morphine consumption, VAS scores at 4, 8, 12, 24, 48 h postoperatively at rest and with swallowing, opioid-related adverse effects	Patients who received preemptive submucosal infiltration with 0.33% ropivacaine expressed significantly decreased pain scores and also demonstrated lower morphine consumption postoperatively.
Chawla et al.1576	2010	3b	Retrospective case–control	Patients who underwent OSA surgery (n = 268) 1. Dexmedetomidine used (n = 125) 2. Dexmedetomidine not used (n = 143)	Mean arterial pressure Use of anti-hypertensives Use of opioids	Dexmedetomidine improves hemodynamic stability in patients undergoing sleep surgery. No difference was noted in opioid dosage between case and control groups.