Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery

Rodrigo Sebastian Parada Heit

doi:doi:10.11648/j.ijacm.20241202.12

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Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery

Rodrigo Sebastian Parada Heit^*

Published in International Journal of Anesthesia and Clinical Medicine (Volume 12, Issue 2)

Received: 25 February 2024 Accepted: 15 April 2024 Published: 29 July 2024

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Abstract

Background: Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. Methods: Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient's sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o'clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. Results: 35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). Conclusions:. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 12, Issue 2)
DOI	10.11648/j.ijacm.20241202.12
Page(s)	73-80
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Opioid Free Anesthesia, Cancer, Pain, Opioid Crisis Prevention, Opioid Misuse, Perioperative Pain Management, ERAS

References

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APA Style

Heit, R. S. P. (2024). Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery. International Journal of Anesthesia and Clinical Medicine, 12(2), 73-80. https://doi.org/10.11648/j.ijacm.20241202.12

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ACS Style

Heit, R. S. P. Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery. Int. J. Anesth. Clin. Med. 2024, 12(2), 73-80. doi: 10.11648/j.ijacm.20241202.12

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AMA Style

Heit RSP. Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery. Int J Anesth Clin Med. 2024;12(2):73-80. doi: 10.11648/j.ijacm.20241202.12

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@article{10.11648/j.ijacm.20241202.12,
  author = {Rodrigo Sebastian Parada Heit},
  title = {Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery
},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {12},
  number = {2},
  pages = {73-80},
  doi = {10.11648/j.ijacm.20241202.12},
  url = {https://doi.org/10.11648/j.ijacm.20241202.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20241202.12},
  abstract = {Background: Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. Methods: Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient's sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o'clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. Results: 35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). Conclusions:. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.
},
 year = {2024}
}

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TY  - JOUR
T1  - Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery

AU  - Rodrigo Sebastian Parada Heit
Y1  - 2024/07/29
PY  - 2024
N1  - https://doi.org/10.11648/j.ijacm.20241202.12
DO  - 10.11648/j.ijacm.20241202.12
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 73
EP  - 80
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20241202.12
AB  - Background: Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. Methods: Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient's sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o'clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. Results: 35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). Conclusions:. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.

VL  - 12
IS  - 2
ER  -

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Rodrigo Sebastian Parada Heit

Anesthesiology Department, Sanatorium Allende, Córdoba, Argentina

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Heit, R. S. P. (2024). Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery. International Journal of Anesthesia and Clinical Medicine, 12(2), 73-80. https://doi.org/10.11648/j.ijacm.20241202.12

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ACS Style

Heit, R. S. P. Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery. Int. J. Anesth. Clin. Med. 2024, 12(2), 73-80. doi: 10.11648/j.ijacm.20241202.12

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AMA Style

Heit RSP. Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery. Int J Anesth Clin Med. 2024;12(2):73-80. doi: 10.11648/j.ijacm.20241202.12

Copy | Download

@article{10.11648/j.ijacm.20241202.12,
  author = {Rodrigo Sebastian Parada Heit},
  title = {Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery
},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {12},
  number = {2},
  pages = {73-80},
  doi = {10.11648/j.ijacm.20241202.12},
  url = {https://doi.org/10.11648/j.ijacm.20241202.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20241202.12},
  abstract = {Background: Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. Methods: Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient's sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o'clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. Results: 35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). Conclusions:. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - Opioid-Free Anesthesia and Analgesic Quality During the Postoperative Period of Oncological Breast Surgery

AU  - Rodrigo Sebastian Parada Heit
Y1  - 2024/07/29
PY  - 2024
N1  - https://doi.org/10.11648/j.ijacm.20241202.12
DO  - 10.11648/j.ijacm.20241202.12
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 73
EP  - 80
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20241202.12
AB  - Background: Pain is one of the most common symptoms in cancer patients. We can understand it as a multifactorial phenomenon. Breast cancer surgical treatment generates real damage to the structures and activates nociception which can generate persistent pain. Current anesthetic management is based on the use of opioids, which generate a large number of complications that can severely affect this group of patients, increasing morbidity and mortality. Opioid-free techniques have been shown to reduce complications and generate optimal anesthetic-analgesic management as well as decrease postoperative misuse. The purpose of this research is to compare both approaches and evaluate their impact on this population group. Methods: Simple, prospective, randomized, controlled blind clinical trial in 30 patients undergoing oncological mammary quadrantectomy a. The patients were divided into two groups study, the first (group A) received balanced general anesthesia with opioids as an analgesic strategy, the other group (group B) received general anesthesia balanced opioid-free supplemented with a PECs II regional block and/or Serratus (BRILMA) according to the patient's sonoanatomy, and ketamine-lidocaine as adjuvant drugs. Analgesia was assessed using the numerical pain scale at 2, 4, and 6 o'clock. The severity and impact of pain on the daily performance of patients were measured using the Brief Pain Inventory (BPI) short form in combination with clinical examination, the presence of postoperative complications, the length of stay in hours and the need for rescue with opioids. Results: 35% of the patients in group A required analgesic rescue with Tramadol to improve pain postoperative, while in group B only 10% needed it. 33% of the patients in group A completed their postoperative period with nausea and vomiting, while in the opioid-free group the percentage was only 1%. Referring to the length of hospital stay from surgery to discharge, group A was hospitalized for a period of 25 hours (SD=21.2), while group B was there for 15.2 hours (SD=8.7). Conclusions:. Use of opioid-free anesthesia along with adjuvant strategies (drugs and nerve blocks) represent a safe and effective anesthetic strategy related with a lower incidence of complications from the use of opioids in the postoperative period, a lower consumption of analgesic rescues, a decrease in the length of hospitalization and a greater degree of comfort for the patient. This protocol represents an alternative when it comes to providing good intra and postoperative conditions for such a susceptible group of patients.

VL  - 12
IS  - 2
ER  -

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