Management of postoperative pain associated with sleep disordered breathing surgery: A systematic review

Postoperative pain is one of the most common and significant complications in patients undergoing surgery for sleep-disordered breathing (SDB), and inadequate pain control may precipitate adverse events and impair postoperative recovery. This systematic review evaluated the effects of various pharmacological and non-pharmacological analgesic interventions on pain following SDB-related surgery, with the aim of identifying potentially optimal postoperative analgesic strategies. A comprehensive search of PubMed, EMBASE, Scopus, Web of Science, CINAHL, the Cochrane Library, and ClinicalTrials.gov, supplemented by manual screening of reference lists, identified 28 randomized controlled trials eligible for inclusion. Across the available evidence, multiple pharmacological approaches-including local anesthetics, non-steroidal anti-inflammatory drugs, corticosteroids, sucralfate, and vitamin C demonstrated varying degrees of analgesic benefit. Non-pharmacological interventions, such as enhanced recovery after surgery protocols, surgical wound cooling, glossopharyngeal nerve block, and patient-controlled analgesia, were also reported to reduce postoperative pain. When opioids were required, intranasal butorphanol appeared to offer a potentially safer alternative based on reported outcomes. Notably, substantial variability in postoperative pain severity among studies was attributable in part to differences in surgical techniques and surgical instruments. These findings underscore the need to integrate postoperative pain considerations into preoperative evaluation and surgical planning for patients with SDB. Collectively, the current evidence supports the use of multimodal analgesia that combines pharmacological and non-pharmacological measures; however, further high-quality trials are warranted to refine postoperative analgesic strategies and to strengthen the evidence base for this patient population.