Sarma Riniki, Gupta Nishkarsh, Gupta Anju, Kumar Vinod, Mishra Seema, Bharati Sachidanand Jee, Garg Rakesh, Gupta Ritu, Gupta Sanjeev Kumar, Deo S V S, Kumar Rajeev, Bhatnagar Sushma
Department of Anesthesia, Pain Medicine and Critical Care, JPNATC, AIIMS, New Delhi, India.
Department of Onco-Anesthesia and Palliative Medicine, AIIMS, Dr BRAIRCH, New Delhi, India.
Indian J Surg Oncol. 2024 Dec;15(4):901-908. doi: 10.1007/s13193-024-02012-x. Epub 2024 Jul 3.
Perioperative opioids are associated with several adverse effects including nausea, vomiting, and long-term addiction. Opioid-free anesthesia may reduce postoperative morbidity, enable daycare surgery, and decrease cancer recurrence. In our study, we aimed to assess the efficacy of opioid-free anesthesia versus opioid-based anesthesia in patients undergoing breast cancer surgery in terms of postoperative opioid use, pain scores, expression of immune cells, and side effects. Hundred patients undergoing breast cancer surgery were randomized into two groups (1:1 ratio). Group O received opioid-based anesthesia and Group N did not receive any opioid intraoperatively. Our primary outcome was total postoperative morphine consumption in 24 h managed with a patient-controlled analgesia (PCA) pump containing morphine in both groups. Secondary outcomes were numerical rating scale (NRS) at rest and movement at immediate postoperative period, 30 min, 1 h, 2 h, 6 h, and 24 h postoperatively was measured. Blood samples were also taken at different time points to measure inflammatory markers. There was no statistical difference in the total 24 h postoperative morphine consumption in between the two groups ( = 0.13). The patient satisfaction scores and NRS at rest and on movement at various time points postoperatively were similar ( > 0.05). There was a significant difference in neutrophil lymphocyte ratio (NLR) between the two groups in the samples taken at 24 h postoperative period ( = 0.03). No complications were reported in any group. While our study did not show opioid-free anesthesia's superiority in postoperative morphine consumption, it established the feasibility and safety of a non-opioid technique for breast cancer surgery. The approach may offer advantages, including potential immunosuppression relief, making it a viable option for patients prone to opioid-related side effects.
围手术期使用阿片类药物会带来多种不良反应，包括恶心、呕吐和长期成瘾。无阿片类药物麻醉可降低术后发病率，实现日间手术，并减少癌症复发。在我们的研究中，我们旨在评估无阿片类药物麻醉与基于阿片类药物麻醉在接受乳腺癌手术患者中的疗效，比较术后阿片类药物使用情况、疼痛评分、免疫细胞表达和副作用。100例接受乳腺癌手术的患者被随机分为两组（1:1比例）。O组接受基于阿片类药物的麻醉，N组术中未使用任何阿片类药物。我们的主要结局指标是两组使用含吗啡的患者自控镇痛（PCA）泵管理的术后24小时吗啡总消耗量。次要结局指标是术后即刻、30分钟、1小时、2小时、6小时和24小时静息和活动时的数字评分量表（NRS）。还在不同时间点采集血样以测量炎症标志物。两组术后24小时吗啡总消耗量无统计学差异（=0.13）。术后各时间点的患者满意度评分以及静息和活动时的NRS相似（>0.05）。术后24小时采集的样本中，两组中性粒细胞淋巴细胞比值（NLR）存在显著差异（=0.03）。两组均未报告并发症。虽然我们的研究未显示无阿片类药物麻醉在术后吗啡消耗量方面的优越性，但它确立了非阿片类技术用于乳腺癌手术的可行性和安全性。该方法可能具有优势，包括潜在的免疫抑制缓解，使其成为易出现阿片类药物相关副作用患者的可行选择。
