Lesser palatine nerve block in multilevel sleep surgery for obstructive sleep apnea: a feasibility and pilot efficacy study

BACKGROUND: To evaluate intraoperative lesser palatine nerve block (LPNB) for postoperative pain control in multilevel sleep surgery for obstructive sleep apnea (OSA).

AIMS AND OBJECTIVES: To evaluate the feasibility of using an intraoperative lesser palatine nerve block (LPNB) to manage postoperative pain in adult patients undergoing multilevel sleep surgery for obstructive sleep apnea.

MATERIALS AND METHODS: Retrospective cohort of 62 adults receiving standardised multimodal analgesia with (n = 35) or without (n = 27) bilateral LPNB (0.5% bupivacaine with epinephrine). Primary outcome: visual analog scale (VAS) pain scores at 6 h and Day 1.

RESULTS: LPNB was feasible and safe with no adverse events across all 35 administrations. A clinically meaningful pain reduction trend at 6 h (3.14 ± 1.33 vs 3.85 ± 1.63; 18% reduction; p = 0.076) and a statistically significant reduction at Day 1 (3.00 ± 1.50 vs 3.89 ± 1.58; 23% reduction; p = 0.027). In the pre specified high risk subgroup of severe OSA patients, exploratory analysis showed significantly lower pain at 6 h (3.00 ± 1.38 vs 4.21 ± 1.42; p = 0.023). On multivariable adjustment, LPNB was associated with reduced odds of moderate to severe pain (adjusted OR 0.38; 95% CI 0.13-1.13; p = 0.082).

CONCLUSIONS AND SIGNIFICANCE: LPNB is feasible, safe, and associated with a clinically meaningful analgesic signal.