title: Continuous lesser palatine nerve block for postoperative analgesia after uvulopalatopharyngoplasty.
abstract: OBJECTIVE
  Uvulopalatopharyngoplasty (UPPP) is a commonly performed surgical intervention used to treat obstructive sleep apnea (OSA) syndrome. Continuous peripheral nerve blocks have been shown to reduce postoperative pain and opioid requirements for other surgical procedures but have not been described previously for palate surgery. We present the use of a continuous lesser palatine nerve block catheter as a part of the multimodal postoperative pain management for UPPP.
  
  
  METHODS
  Three patients were scheduled to undergo elective UPPP and tonsillectomy for OSA with scheduled postoperative hospital admission. Each patient gave written consent to share the details of his or her case. Upon completion of the surgical procedure, but before emergence from general anesthesia, a 20-G multiorifice epidural catheter was inserted into the left nasal passage, passed into the oropharynx, and either tunneled posteriorly within the anterior portion of the soft palate with the aid of a 16-G angiocatheter or placed submucosally within the soft palate by the surgeon. Each catheter was secured using clear adhesive dressings along the cheek and anchored to the ipsilateral shoulder. A continuous infusion of ropivacaine 0.2% at 2 mL/h was delivered using a disposable infusion device postoperatively, in addition to the prescribed oral and intravenous opioids. No immediate or long-term complications due to catheter placement were identified during the patient follow-up.
  
  
  CONCLUSIONS
  Continuous lesser palatine nerve block may be a useful regional anesthetic technique in the multimodal postoperative pain management of opioid-sensitive OSA patients undergoing UPPP and deserves further study.
authors.affiliation: *Department of Anesthesia †Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Nathaniel A
authors.initials: NA
authors.lastname: Ponstein
authors.forename: Tae-Wu Edward
authors.initials: TW
authors.lastname: Kim
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hsia
authors.forename: Richard
authors.initials: R
authors.lastname: Goode
authors.forename: Paula
authors.initials: P
authors.lastname: Borges
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
mesh_terms: D000328:Adult; D000577:Amides / Q000627:therapeutic use*; D000698:Analgesia / Q000379:methods; D000779:Anesthetics, Local / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D019647:Oral Surgical Procedures / Q000009:adverse effects*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010159:Palate / Q000601:surgery; D010614:Pharynx / Q000601:surgery; D000077212:Ropivacaine; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D016896:Treatment Outcome; D014609:Uvula / Q000601:surgery
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine