Regional anesthesia and pain management in patients with sleep apnea: can they improve outcomes?

PURPOSE OF REVIEW: In several guidelines, regional anesthesia and analgesia have been suggested as safer alternatives for general anesthesia and systemic analgesia for their safety profile in patients suffering from obstructive sleep apnea (OSA). However, the underlying scientific basis is still evolving. The present review is intended to provide an up-to-date account on the question whether the use of regional anesthesia improves outcomes in patients with OSA. RECENT FINDINGS: A number of studies found favorable effects of regional anesthesia used in patients with OSA, including reduced incidence of major perioperative complications such as the need for mechanical ventilation, reintubation and pulmonary/cardiac complications. No negative effects of regional anesthesia specific to patients with OSA were found. Regional anesthesia was most effective when used as a sole technique, but also carried benefits when added to general anesthesia. The majority of available literature focuses on orthopedic surgery and neuraxial anesthesia. SUMMARY: Regional anesthesia can be recommended as a good strategy to treat patients with OSA whenever feasible, as it reduces the incidence of potentially catastrophic perioperative complications. However, the breadth of both surgical and regional anesthetic techniques analyzed is limited; further research should focus on extending the knowledge base beyond neuraxial anesthesia and orthopedics.