Analgesia and patient comfort after enhanced recovery after surgery in uvulopalatopharyngoplasty: a randomised controlled pilot study

Abstract

Background Uvulopalatopharyngoplasty(UPPP) is the most prevalent surgical treatment of obstructive sleep apnea, but postoperative pharyngeal pain may affect patient comfort. The enhanced recovery after surgery pathway has been proved beneficial to many types of surgery but not to UPPP yet. The aim of this pilot study was to preliminarily standrize an enhanced recovery after surgery protocol for UPPP, to assess whether it has positive effects on reducing postoperative pharyngeal pain and improving patient comfort, and to test its feasibility for an international multicentre study. Methods This randomised controlled study analysed 116 patients with obstructive sleep apnoea (OSA) who were undergoing UPPP in a single tertiary care hospital. They were randomly divided according to treatment: the ERAS group (those who received ERAS treatment) and the control group (those who received traditional treatment). Ninety-five patients completed the assessment (ERAS group, 59 patients; control group, 36 patients). Pharyngeal pain and patient comfort were evaluated using a visual analogue scale (VAS) at 30 min and at 6, 12, 24 and 48 h after UPPP. Complications, hospitalisation duration, and hospital cost were recorded. Results The VAS scores for resting pain and swallowing pain were significantly lower in the ERAS group than those in the control group at 30 min and at 6, 12, 24 and 48 h after surgery. Patient comfort was improved in the ERAS group. The hospitalisation duration and cost were comparable between the groups. The incidence of complications showed an increasing trend in the ERAS group. Conclusion The ERAS protocol significantly relieved pharyngeal pain after UPPP and improved comfort in patients with OSA, which showed the prospect for an larger study. Meanwhile a potential increase of post-operative complications in the ERAS group should be noticed. Trial registration Chinese Clinical Trial Registry (23/09/2018, ChiCTR1800018537)

The application of gargle containing honeysuckle and semen oroxyli to reduce the pain and complications after uvulopalatopharyngoplasty

“…However, in the present study, we observed that the gargle did not reduce the numbers of patients with wound infection or bleeding after UPPP. It has been reported that occurrence rate of post-UPPP wound infection or bleeding is very low ( Huang et al, 2021 ). Thus, to determine the preventive effect of the gargle containing honeysuckle and semen oroxyli on post-UPPP wound infection or bleeding, we need larger sample size.…”

“…In this study, OSA was diagnosed through polysomnography according to the international classification of sleep disorders approved by the America Academy of Sleep Medicine ( Huang et al, 2021 ). The exclusion criteria were as followed: ( Lee et al, 2021 ): patients with a history of systemic diseases such as severe cardiac and/or pulmonary disorders; ( Franklin and Lindberg, 2015 ); patients who were unable to cooperate with evaluations; ( Huang et al, 2021 ); patients with severe diabetes; ( Sommer et al, 2016 ); patients who had underwent other surgeries in the last 6 months.…”

“…Over 4% of men and 2% of women in the world are affected by this disease ( Franklin and Lindberg, 2015 ). Untreated OSA is associated with a series of serious cardiovascular complications such as hypertension, coronary artery disease and heart failure, with increased mortality ( Huang et al, 2021 ). Various neurodegenerative disorders have also been suspected to be associated with OSA ( Lee et al, 2021 ).…”

“…Uvulopalatopharyngoplasty (UPPP) is the major treatment for OSA, which could relieve the obstruction of upper airway via shortening the uvula and soft palate or in company with tonsillectomy ( Huang et al, 2021 ). The efficacy of UPPP to treat OSA has been demonstrated in two former randomized controlled trials ( Browaldh et al, 2013 ; Sommer et al, 2016 ).…”