Opioid-free anesthesia for breast cancer surgery: An observational study

Swagata Tripathy, Satyajit Rath, Suresh Agrawal, P Bhaskar Rao, A Panda, T S Mishra, Sukdev Nayak, Swagata Tripathy, Satyajit Rath, Suresh Agrawal, P Bhaskar Rao, A Panda, T S Mishra, Sukdev Nayak

Abstract

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.

Keywords: Analgesics; PECS; mastectomy; nerve block; non-narcotic; opioid; opioid analgesics; opioid-free anesthesia; radical.

Conflict of interest statement

There are no conflicts of interest.

References

    1. Bokhari F, Sawatzky JA. Chronic neuropathic pain in women after breast cancer treatment. Pain Manag Nurs. 2009;10:197–205.
    1. Martin JL, Koodie L, Krishnan AG, Charboneau R, Barke RA, Roy S. Chronic morphine administration delays wound healing by inhibiting immune cell recruitment to the wound site. Am J Pathol. 2010;176:786–99.
    1. Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. Br J Anaesth. 2010;105:106–15.
    1. Exadaktylos AK, Buggy DJ, Moriarty DC, Mascha E, Sessler DI. Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006;105:660–4.
    1. Fodale V, D'Arrigo MG, Triolo S, Mondello S, La Torre D. Anesthetic techniques and cancer recurrence after surgery. Scientific World Journal. 2014;2014 Article ID 328513.
    1. Patil SK, Anitescu M. Opioid-free perioperative analgesia for hemicolectomy in a patient with opioid-induced delirium: A case report and review of the analgesic efficacy of the alpha-2 agonist agents. Pain Pract. 2012;12:656–62.
    1. Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: A systematic review and a meta-analysis. Br J Anaesth. 2014;112:991–1004.
    1. Mulier JP. Opioid free anaesthesia (OFA) a Paradigma shift? 2015. [Last accessed on 2017 Jun 11]. Retrieved from .
    1. Mulier JP, Wouters R, and Dekock M. Pourquoi et comment éviter les opioïdes en anesthésie ambulatoire? Non-opioid surgical anaesthesia. Presented at JEPU Conference, Paris. 2014
    1. Sultana A. [Last accessed on 2017 Jan 19];Opioid free anesthesia and analgesia in the bariatric patient. Available at: .
    1. Lynch EP, Welch KJ, Carabuena JM, Eberlein TJ. Thoracic epidural anesthesia improves outcome after breast surgery. Ann Surg. 1995;222:663–9.
    1. Greengrass R, O'Brien F, Lyerly K, Hardman D, Gleason D, D'Ercole, et al. Paravertebral block for breast cancer surgery. Can J Anaesth. 1996;43:858–61.
    1. Weltz CR, Greengrass RA, Lyerly HK. Ambulatory surgical management of breast carcinoma using paravertebral block. Ann Surg. 1995;222:19–26.
    1. Pusch F, Freitag H, Weinstabl C, Obwegeser R, Huber E, Wildling E. Single-injection paravertebral block compared to general anaesthesia in breast surgery. Acta Anaesthesiol Scand. 1999;43:770–4.
    1. Bashandy GM, Abbas DN. Pectoral nerves I and II blocks in multimodal analgesia for breast cancer surgery: A randomized clinical trial. Reg Anesth Pain Med. 2015;40:68–74.
    1. Kulhari S, Bharti N, Bala I, Arora S, Singh G. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: A randomized controlled trial. Br J Anaesth. 2016;117:382–6.
    1. Wahba SS, Kamal SM. Thoracic paravertebral block versus pectoral nerve block for analgesia after breast surgery. Egyptian J Anaesth. 2014;30:129–35.
    1. Tripathy S, Hansda U, Seth N, Rath S, Rao PB, Mishra TS, et al. Validation of the EuroQol five-dimensions - Three-level quality of life instrument in a classical Indian language (Odia) and its use to assess quality of life and health status of cancer patients in Eastern India. Indian J Palliat Care. 2015;21:282–8.
    1. Balandin VV, Gorobec ES. Opioid-free anesthesia, analgesia and sedation in surgery of head and neck tumor. Anesteziol Reanimatol. 2015;60:39–42.
    1. Mansour MA, Mahmoud AA, Geddawy M. Nonopioid versus opioid based general anesthesia technique for bariatric surgery: A randomized double-blind study. Saudi J Anaesth. 2013;7:387–91.
    1. Blanco R, Fajardo M, Parras T. Ultrasound description of Pecs II (modified Pecs I): A novel approach to breast surgery. Rev Esp Anestesiol Reanim. 2012;59:470–5.
    1. Chakraborty A, Khemka R, Datta T, Mitra S. COMBIPECS, the single-injection technique of pectoral nerve blocks 1 and 2: A case series. J Clin Anesth. 2016;35:365–8.
    1. Sebastian MP. Pecs II or serratus plane block? Anaesthesia. 2014;69:1173.
    1. Del Buono R, Costa F, Agrò FE. Parasternal, pecto-intercostal, Pecs, and transverse thoracic muscle plane blocks: A rose by any other name would smell as sweet. Reg Anesth Pain Med. 2016;41:791–2.
    1. Abdallah FW, Brull R. Facilitatory effects of perineural dexmedetomidine on neuraxial and peripheral nerve block: A systematic review and meta-analysis. Br J Anaesth. 2013;110:915–25.
    1. Blaudszun G, Lysakowski C, Elia N, Tramer MR. Effect of perioperative systemic α2 agonists on postoperative morphine consumption and pain intensity. Anesthesiology. 2012;116:1312–22.
    1. Castro A. [Last accessed on 2017 May 02];Opioid free anaesthesia [PDF Document] Retrieved from .

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