Opioid-free anesthesia for breast cancer surgery: An observational study
Background and Aims: Opioids are associated with postoperative nausea, vomiting, drowsiness, and increased analgesic requirement. A nonopioid anesthesia technique may reduce morbidity, enable day care surgery, and possibly decrease tumor recurrence. We compared opioid-free, nerve block-based anesthe...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2018-01-01
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| Series: | Journal of Anaesthesiology Clinical Pharmacology |
| Subjects: | |
| Online Access: | http://www.joacp.org/article.asp?issn=0970-9185;year=2018;volume=34;issue=1;spage=35;epage=40;aulast=Tripathy |
| _version_ | 1819206358670508032 |
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| author | Swagata Tripathy Satyajit Rath Suresh Agrawal P Bhaskar Rao A Panda T S Mishra Sukdev Nayak |
| author_facet | Swagata Tripathy Satyajit Rath Suresh Agrawal P Bhaskar Rao A Panda T S Mishra Sukdev Nayak |
| author_sort | Swagata Tripathy |
| collection | DOAJ |
| description | Background and Aims: Opioids are associated with postoperative nausea, vomiting, drowsiness, and increased analgesic requirement. A nonopioid anesthesia technique may reduce morbidity, enable day care surgery, and possibly decrease tumor recurrence. We compared opioid-free, nerve block-based anesthesia with opioid-based general anesthesia for breast cancer surgery in a prospective cohort study.
Material and Methods: Twenty four adult American Society of Anesthesiologists grade I–III patients posted for modified radical mastectomy (MRM) with axillary dissection were induced with propofol and maintained on isoflurane (0.8–1.0 minimum alveolar concentration) through i-gel on spontaneous ventilation and administered ultrasound-guided PECS 1 and 2 blocks (0.1% lignocaine + 0.25% bupivacaine + 1 mcg/kg dexmedetomidine, 30 ml). Postoperative nausea, pain scores, nonopioid analgesic requirement over 24 h, stay in the recovery room, and satisfaction of surgeon and patient were studied. Twenty-four patients who underwent MRM and axillary dissection without a nerve block under routine opioid anesthesia with controlled ventilation were the controls.
Results: MRM and axillary dissection under the nonopioid technique was adequate in all patients. Time in the recovery room, postoperative nausea, analgesic requirement, and visual analog scale scores were all significantly less in the nonopioid group. Surgeon and patient were satisfied with good patient quality of life on day 7.
Conclusion: Nonopioid nerve block technique is adequate and safe for MRM with axillary clearance. Compared to conventional technique, it offers lesser morbidity and may allow for earlier discharge. Larger studies are needed to assess the long-term impact on chronic pain and tumor recurrence by nonopioid techniques. |
| first_indexed | 2024-12-23T05:06:20Z |
| format | Article |
| id | doaj.art-2f18cc657e9140f598f58691c1f85483 |
| institution | Directory Open Access Journal |
| issn | 0970-9185 |
| language | English |
| last_indexed | 2024-12-23T05:06:20Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Anaesthesiology Clinical Pharmacology |
| spelling | doaj.art-2f18cc657e9140f598f58691c1f854832022-12-21T17:59:04ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology0970-91852018-01-01341354010.4103/joacp.JOACP_143_17Opioid-free anesthesia for breast cancer surgery: An observational studySwagata TripathySatyajit RathSuresh AgrawalP Bhaskar RaoA PandaT S MishraSukdev NayakBackground and Aims: Opioids are associated with postoperative nausea, vomiting, drowsiness, and increased analgesic requirement. A nonopioid anesthesia technique may reduce morbidity, enable day care surgery, and possibly decrease tumor recurrence. We compared opioid-free, nerve block-based anesthesia with opioid-based general anesthesia for breast cancer surgery in a prospective cohort study. Material and Methods: Twenty four adult American Society of Anesthesiologists grade I–III patients posted for modified radical mastectomy (MRM) with axillary dissection were induced with propofol and maintained on isoflurane (0.8–1.0 minimum alveolar concentration) through i-gel on spontaneous ventilation and administered ultrasound-guided PECS 1 and 2 blocks (0.1% lignocaine + 0.25% bupivacaine + 1 mcg/kg dexmedetomidine, 30 ml). Postoperative nausea, pain scores, nonopioid analgesic requirement over 24 h, stay in the recovery room, and satisfaction of surgeon and patient were studied. Twenty-four patients who underwent MRM and axillary dissection without a nerve block under routine opioid anesthesia with controlled ventilation were the controls. Results: MRM and axillary dissection under the nonopioid technique was adequate in all patients. Time in the recovery room, postoperative nausea, analgesic requirement, and visual analog scale scores were all significantly less in the nonopioid group. Surgeon and patient were satisfied with good patient quality of life on day 7. Conclusion: Nonopioid nerve block technique is adequate and safe for MRM with axillary clearance. Compared to conventional technique, it offers lesser morbidity and may allow for earlier discharge. Larger studies are needed to assess the long-term impact on chronic pain and tumor recurrence by nonopioid techniques.http://www.joacp.org/article.asp?issn=0970-9185;year=2018;volume=34;issue=1;spage=35;epage=40;aulast=TripathyAnalgesicsnerve blockmastectomynon-narcoticopioidopioid analgesicsopioid-free anesthesiaPECSradical |
| spellingShingle | Swagata Tripathy Satyajit Rath Suresh Agrawal P Bhaskar Rao A Panda T S Mishra Sukdev Nayak Opioid-free anesthesia for breast cancer surgery: An observational study Journal of Anaesthesiology Clinical Pharmacology Analgesics nerve block mastectomy non-narcotic opioid opioid analgesics opioid-free anesthesia PECS radical |
| title | Opioid-free anesthesia for breast cancer surgery: An observational study |
| title_full | Opioid-free anesthesia for breast cancer surgery: An observational study |
| title_fullStr | Opioid-free anesthesia for breast cancer surgery: An observational study |
| title_full_unstemmed | Opioid-free anesthesia for breast cancer surgery: An observational study |
| title_short | Opioid-free anesthesia for breast cancer surgery: An observational study |
| title_sort | opioid free anesthesia for breast cancer surgery an observational study |
| topic | Analgesics nerve block mastectomy non-narcotic opioid opioid analgesics opioid-free anesthesia PECS radical |
| url | http://www.joacp.org/article.asp?issn=0970-9185;year=2018;volume=34;issue=1;spage=35;epage=40;aulast=Tripathy |
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