The Relationship Between Postoperative Opioid Analgesia and Sleep Apnea Severity in Patients Undergoing Hip Arthroplasty: A Randomized, Controlled, Triple-Blinded Trial.

Residual postoperative pain after hip arthroplasty is usually treated with oral opioids. While classic opioids are associated with respiratory depression and worsening of sleep apnea, tramadol has been reported to preserve respiratory function. However, this has not been investigated in a prospective trial using respiratory polygraphy. This randomized controlled triple-blinded trial tested the hypothesis that postoperative treatment with oral opioids such as oxycodone would increase sleep apnea severity, measured with a respiratory polygraphy, compared with oral tramadol. Sixty patients undergoing hip arthroplasty under spinal anesthesia with 15 mg isobaric bupivacaine 0.5% were randomized to receive postoperative pain treatment with either oral oxycodone (controlled-release 10 mg every 12 hours and immediate-release 5 mg every 4 hours as needed) or oral tramadol (controlled-release 100 mg every 8 hours and immediate-release 50 mg every 4 hours as needed). Respiratory polygraphy was performed on the first postoperative night. The primary outcome was the apnea-hypopnea index in the supine position. Secondary outcomes included the oxygen desaturation index, postoperative pain scores and intravenous morphine consumption. Mean supine apnea-hypopnea index on postoperative night 1 was 11.3 events.h Oral oxycodone did not increase sleep apnea severity measured using respiratory polygraphy compared with oral tramadol on the first postoperative night after hip arthroplasty. Clinicaltrials.gov - NCT03454217 (date of registration: 05/03/2018).

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© 2022 Albrecht et al.

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EA has received grants from the Swiss Academy for Anesthesia Research (SACAR), Lausanne, Switzerland (50,000 CHF, no grant number attributed), and from B. Braun Medical AG (56,100 CHF, no grant number attributed). EA has also received honoraria from B. Braun Medical AG, from Sintetica Ltd UK and MSD AG. JW reports grants, personal fees from Stryker, Lima corporate, Dedienne santé, outside the submitted work and reports royalties received from Dedienne Santé; Paid consultant of Stryker and Lima Corporate; Research funding from Stryker; Editorial board member of the Journal of Arthroplasty and International Orthopaedics. RH is member of the medical advisory board of Dreem, Nightbalance and Philips and received consultant's or speaker's fees from Resmed, Jazz Medical, Philips and Inspire. Other authors have no competing interest in this work.