Effect of opioid-free anesthesia combined with pectoral nerve block on the quality of recovery in patients after mastectomy: A randomized, controlled trial

Abstract

Objective To evaluate the impact of opioid-free anesthesia (OFA) combined with regional blocks on the quality of recovery (QoR) in patients who underwent mastectomy. Methods This randomized controlled trial involved 132 mastectomy patients who were randomized to receive either OFA combined with PECS block or opioid-based anesthesia (OBA) combined with PECS block. The QoR was assessed using the QoR-15 global score at 24 h post-surgery. Secondary outcomes included postoperative sufentanil consumption, incidence of postoperative nausea and vomiting (PONV), Numerical Rating Scale (NRS) scores at 1, 4, and 24 h, incidence of postoperative adverse events, extubation, incidence of severe bradycardia and intraoperative mean artrial pressure (MAP) and heart rate (HR) at after entering the operating room (T0, baseline value), after intubation (T1), after skin incision (T2), and after extubation (T3). Results The QoR-15 global score at 24 h was not significantly different between groups (MD = -0.4, 95% CI [-3.8 to 4.7], P= 0.67). Postoperative sufentanil consumptions (P= 0.075), the incidence of PONV (P= 0.12), NRS scores at 1 h (P= 0.36), 4 h (P= 0.53), and 24 h (P= 0.02) were not significantly different. Incidence of adverse events (OR = 0, 95% CI [0 to 0.44], P= 0.0063) were lower in Group OFA than that in Group OBA. Extubation time was significantly longer in Group OFA than in Group OBA (MD = 15, 95%CI [10–18], P < 0.001). MAPs at T1 and T2 were significantly higher in Group OFA than in Group OBA (P < 0.0125), while MAP and HR at T3 were significantly lower in Group OFA than in Group OBA(P < 0.0125). Incidence of severe bradycardia were not significantly different (P=0.67). Conclusion In conclusion, while OFA contributes to a reduction in adverse events, its integration with PECS blocks does not improve QoR or postoperative analgesia at 24h post-mastectomy. Moreover, OFA was associated with a prolonged extubation time.