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.