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Opioid-sparing postoperative pain in OSA — FRCA Final MCQ

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HardPerioperative MedicineOpioid-sparing postoperative pain in OSAFRCA Final

A 46-year-old woman with obstructive sleep apnoea is in recovery after mastectomy and axillary surgery. She is drowsy after intra-operative morphine, SpO2 falls to 90% when asleep, and pain score is 7/10 despite paracetamol and ibuprofen. What is the most appropriate pain management?

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Correct answer: E — Use opioid-sparing multimodal analgesia with regional rescue and monitored respiratory support

OSA with opioid-related desaturation calls for opioid-sparing analgesia, reassessment for regional rescue techniques and monitored respiratory support including CPAP where appropriate. Repeated long-acting opioids risk worsening airway obstruction and hypoventilation. Withholding analgesia is also harmful because pain impairs breathing and recovery. The safest plan treats pain and ventilatory risk together.

Reference: Association of Anaesthetists OSA peri-operative guidance; Faculty of Pain Medicine acute pain guidance