Transnasal butorphanol for pain relief after uvulopalatopharyngoplasty - a hospital-based,randomized study

Nasal spray of analgesic is a novel administration for postoperative pain control. In this study, we assessed the efficacy of transnasal butorphanol (TB) for pain relief following uvulopalatopharyngoplasty (UPPP) in obstructive sleep apnea (OSA) patients, and compared pain alleviation effect to oral mefenamic acid and intramuscular meperidine (M> or =&M).

A prospective, randomized, open label study was conducted in a tertiary care sleep center. Twelve OSA patients with full consciousness and at least moderate oropharyngeal pain (pain visual analogue scale [VAS] > or = 4) after UPPP were recruited. They were randomized to receive TB (n = 7) and M&M (n = 5). Oropharyngeal pain was measured by a VAS and the Clinical Global Impression in Severity (CGI-S) and Improvement (CGI-I) at the 12th, 24th, and 72th hours postoperatively. Postoperative pain related morbidities (PRMs) and quality of life in bodily pain (QOL-BP) were also evaluated 72 hours postoperatively. Adverse events incurred by pain treatment were carefully monitored during patients' hospitalizations.

No major complication occurred throughout the study. Analysis of clinical measures revealed significantly improved VAS (p = 0.04), CGI-S (p = 0.03), and CGI-I (p = 0.02) in the TB group. However, no significant difference (p > 0.05) in the degree of pain relief was found between the two groups, as denoted by aforementioned three variables, PRMs, and QOL-BP.

Administration of TB can significantly alleviate the wound pain after UPPP in OSA patients. This study also confirmed the safety of TB in patients undergoing oropharyngeal surgery.