Optimizing Analgesia: Opioid-Sparing Alternatives for Obstructive Sleep Apnea

Abstract

Purpose: The purpose of this quality improvement project was to educate anesthesia providers about use of four non-opioid intravenous (IV) agents—dexmedetomidine, ketamine, magnesium, and lidocaine—for opioid-sparing analgesia in patients with obstructive sleep apnea (OSA). Project aimed to evaluate changes in provider intent, perceptions, and attitudes toward implementing these agents in clinical practice. Background: OSA is a prevalent sleep disorder characterized by recurrent airway collapse, increased perioperative risks such as respiratory depression and hypoxia, particularly with opioid use. American Society of Anesthesiologists recommends opioid-sparing techniques for OSA patients, yet specific guidance on pharmacological alternatives remains limited. Evidence from general surgical populations suggests four non-opioid agents of interest may effectively reduce opioid consumption and improve analgesic outcomes. Methods: An educational session was developed and delivered virtually to anesthesia providers employed by anesthesia group at a single facility. Pre-survey assessed baseline provider intent, perceptions, and attitudes regarding opioid-sparing strategies. Following 15-minute video presentation, post-survey evaluated changes in these metrics and identified barriers to implementation. Data from paired pre- and post-survey responses were analyzed using Wilcoxon Signed-Rank Test for statistical significance. Open-ended responses were analyzed qualitatively to identify recurring themes. Results: Ten anesthesia providers completed both pre- and post-surveys. A statistically significant increase in their confidence and intention to use non-opioid intravenous agents for opioid-sparing analgesia in patients with OSA, as evidenced by changes in post-survey 12 responses. Wilcoxon Signed-Rank Test revealed significant improvements in confidence in understanding of benefits of ketamine, dexmedetomidine, magnesium, and lidocaine for patients with OSA (p = 0.035), as well as increases in intent to use opioid-sparing techniques (p = 0.02). Providers also reported greater awareness of importance of minimizing opioid use in population (p = 0.009). Qualitative analysis revealed logistical barriers, 40% of participants reporting barriers to utilize interventions that included: limited access to agents in operating rooms and dosing issues, particularly with ketamine being supplied in impractical large vials. Conclusions: Project demonstrated that educational session effectively increased anesthesia providers' confidence and willingness to implement opioid-sparing techniques for OSA patients. However, logistical barriers, such as limited access to certain agents, may impact widespread use of these techniques