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Otsuka rejoined the Padres organization in 2017 when he was announced as the bullpen coach of the El Paso Chihuahuas, the AAA affiliate of the Padres.

In 2016, with first team pitching coach Shinichi Kondoh on leave to have hernia surgery, Otsuka helped lead the first team pitchers in spring camp. He however returned to working with the second team following Kondoh's return. On 26 September, Otsuka was unveiled as the pitching coach for the U-23 Japanese national team for the 2016 WBSC U-23 World Cup.

Otsuka returned to the Chunichi Dragons on the 3rd of October 2015 as one of the second team pitching coaches.

Otsuka was the player-manager of the Shinano Grandserows of the Japanese Baseball Challenge League from 2012–2014. The team held his retirement ceremony on September 15, 2014.

On January 10, 2008, Otsuka announced that he would undergo elbow surgery.

On January 6, 2006, Otsuka was traded to the Rangers, along with pitcher Adam Eaton and minor league catcher Billy Killian, in exchange for pitcher Chris Young, first baseman Adrián González, and outfielder Terrmel Sledge.

Otsuka took over the role as the closer for the Rangers during the 2006 season, replacing Francisco Cordero, and recorded 32 saves while posting a 2.11 ERA. However, on December 19, 2006, the Rangers announced that newly signed Éric Gagné would take over the closer role in 2007, with Otsuka moving back into a set-up role. On January 13, 2007, T. R. Sullivan reported that, in an interview in Japan, Otsuka said "If there is the team which needs me as a closer, I am going to think about (the trade)". Due to Gagné starting the season on the DL, Otsuka began the 2007 season as the closer. With the trade of Gagne to the Boston Red Sox, Otsuka assumed the closer's role again. However, Otsuka went on the DL after experiencing tightness in his throwing shoulder. His stand-in was C. J. Wilson. Otsuka was not offered a new contract by the Rangers and became a free agent on December 12, 2007.

Otsuka made his major league debut April 6, 2004 against the Los Angeles Dodgers, earning the loss after giving up a walk-off single to Robin Ventura. He struck out Paul Lo Duca for his first major league strikeout.

Otsuka came to the United States after several years of pitching in the Japanese League when his former team, the Chunichi Dragons, used the posting system to solicit bids from MLB clubs for the right to negotiate with him. The Padres offered the top bid, and signed him to a three-year contract on December 9, 2003.

Akinori Otsuka (大塚 晶則 , Ōtsuka Akinori) (born January 13, 1972) is a retired Japanese baseball pitcher who coaches for the Chunichi Dragons in Nippon Professional Baseball. He was formerly the set-up man for the San Diego Padres and the Texas Rangers. He was also the closer for Japan's 2006 World Baseball Classic winning team.