Abstract
Background Acute postoperative pain (APP) has a high incidence in breast surgery, and opioids are the most commonly used drugs for its management; however, they are not free from systemic side effects, which may increase comorbidity. In the past few years, opioid-free anaesthesia has been favoured with promising results. Methods We conducted a descriptive study including 71 patients who underwent breast cancer surgery. The opioid group (n = 41) received fentanyl for induction, remifentanil for maintenance, and rescue morphine before waking up, whereas the ketamine group (n = 30) received a ketamine bolus for induction followed by continuous ketamine infusion during surgery. Later, the presence and intensity of pain were registered, using the Numeric Rating Scale (NRS 1–10) for pain, at different times in the recovery room, at 24 hours and at 3 months. Results Administration of ketamine is more effective than opioid use for APP prevention in breast cancer surgery because the ketamine group presented with less pain than the opioid group (p < 0.05) at all measured times. When there was pain, patients in the ketamine group gave a lower score to its intensity (p < 0.05). Conclusions Ketamine could reduce the incidence of APP in breast cancer surgery, compared to opioids.
Highlights
Acute postoperative pain (APP) has an incidence of 77–86% depending on the type of surgery, the analgesia received, and the type of patient [1]
With the purpose of improving analgesia while reducing the side effects of opioids, multimodal analgesia appeared, which includes opioid-less anaesthesia (OLA) and opioidfree anaesthesia (OFA) [7,8,9,10,11,12,13,14,15,16,17]. e patients who benefit most from this mainstream are those for which opioid use presents higher comorbidity, such as patients at risk of postoperative nausea and vomiting (PONV), obese patients, patients with a chronic pulmonary disease, or patients undergoing cancer surgery in which opioid administration has been associated with tumour progression [18]
Ketamine was associated with a lower probability of pain at 10 min after extubation (Table 3), reducing by 83.1% the risk of having pain in comparison with the opioid group (Table 3)
Summary
Acute postoperative pain (APP) has a high incidence in breast surgery, and opioids are the most commonly used drugs for its management; they are not free from systemic side effects, which may increase comorbidity. In the past few years, opioid-free anaesthesia has been favoured with promising results. We conducted a descriptive study including 71 patients who underwent breast cancer surgery. Administration of ketamine is more effective than opioid use for APP prevention in breast cancer surgery because the ketamine group presented with less pain than the opioid group (p < 0.05) at all measured times. Patients in the ketamine group gave a lower score to its intensity (p < 0.05). Ketamine could reduce the incidence of APP in breast cancer surgery, compared to opioids
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