Redefining perioperative analgesia: Impact of opioid-free anesthesia in breast surgery.

BACKGROUND AND

OBJECTIVES

Opioid-free anesthesia (OFA) aims to achieve effective perioperative pain control while avoiding the adverse effects associated with opioid use. Its usefulness in breast surgery remains poorly studied. The primary objective of this study was to compare morphine consumption in the post-anesthesia care unit (PACU) between patients undergoing opioid-free anesthesia and those receiving conventional opioid-based anesthesia.

MATERIALS AND

METHODS

A retrospective, observational, single-center study was conducted at the University Hospital of A Coruña. A total of 87 patients who underwent breast surgery between January and July 2022 were included. Two groups were compared: opioid-free anesthesia (OFA, n = 41) and conventional opioid-based anesthesia (non-OFA, n = 46). The need for morphine rescue at PACU discharge, at 24 h, and at 48 h postoperatively (if patients remained hospitalized) was recorded. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), oral tolerance, night rest, and length of stay in the PACU and hospital.

RESULTS

The OFA group showed significantly lower morphine consumption in the recovery unit (9.8% vs. 47.8%; P < .001), with an absolute risk reduction of 38.1%. No PONV events were observed in the OFA group compared with 21.7% in the non-OFA group (P = .001). Delayed oral tolerance was more frequent in the non-OFA group (0% vs. 15.2%; P = .013), and night rest was also better in the OFA group (94.4% vs. 65.7%; P < .05). No differences were found in PACU or hospital length of stay.

DISCUSSION: The OFA technique provided adequate analgesic control with a significant reduction in postoperative adverse effects.

CONCLUSIONS

Opioid-free anesthesia in breast surgery is a safe and effective technique that improves postoperative recovery.