Abstract
BackgroundBreast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), although opioids are associated with several adverse events, including nausea, vomiting, and constipation. Multimodal opioid-free anesthesia (OFA) has been introduced to reduce the incidence of these side effects. In this single-center retrospective study, we investigated whether ketamine, combined with magnesium and clonidine, could effectively control postoperative pain in patients undergoing quadrantectomy, while reducing postoperative nausea and vomiting (PONV).ResultsA total of 89 patients submitted to quadrantectomy were included and divided into an OFA group (38 patients) and an OIA group (51 patients) according to the received anesthetic technique. Analgesia in the OIA group was based on an intraoperative infusion of remifentanil, and analgesia in the OFA consisted of an intraoperative infusion of ketamine and magnesium sulfate. Postoperative pain in both groups was managed with nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol. Postoperative pain, assessed with the numeric rating scale (NRS), requirements for additional analgesics, the incidence of PONV, and patient satisfaction evaluated using a QoR-40 questionnaire were compared between the two groups. Levels of pain at 30 min and 6, 12, and 24 h after surgery; number of paracetamol rescue doses; and the incidence of PONV were lower in the OFA group (p <0.05). Patient satisfaction was comparable in the two groups.ConclusionsA combination of ketamine, magnesium, and clonidine could be more effective than opioid-based analgesia in reducing postoperative pain and lowering PONV occurrence after quadrantectomy for breast cancer.
Highlights
Breast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), opioids are associated with several adverse events, including nausea, vomiting, and constipation
A significant percentage of patients (20–65%) experience chronic postoperative pain (CPOP), which is closely associated with perceived disability long after recovery from the surgical insult and greatly impacts the quality of life [21, 24, 26]
(2021) 1:6 which involves the administration of intraoperative opioids, either in boluses or by target-controlled infusion
Summary
Breast cancer surgery is usually managed using opioid-inclusive anesthesia (OIA), opioids are associated with several adverse events, including nausea, vomiting, and constipation. Multimodal opioid-free anesthesia (OFA) has been introduced to reduce the incidence of these side effects In this single-center retrospective study, we investigated whether ketamine, combined with magnesium and clonidine, could effectively control postoperative pain in patients undergoing quadrantectomy, while reducing postoperative nausea and vomiting (PONV). Opioids’ intraoperative administration is burdened by side effects such as acute tolerance and postoperative paradoxical hyperalgesia [2]. The latter is caused by neuronal changes involving both the central and peripheral nervous systems, which result in sensitization of pain pathway s[25], and an increase in acute postoperative pain [1, 20]
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