Opioid-Free Anesthesia Versus Opioid-Balanced Anesthesia in Breast Surgeries: A Randomized Study

Introduction Opioids, the conventional analgesics, have adverse effects such as postoperative nausea and vomiting (PONV). The opioid-free anesthesia (OFA) protocols are now being formulated to provide equally efficacious analgesia with reduced adverse effects as opioid-balanced anesthesia (OBA). The primary objective was to compare the Quality of Recovery score (QoR-15 score) and intraoperative hemodynamic parameters between OFA and OBA. The secondary objectives were to compare the visual analog scale (VAS) scores, the number of patients requiring rescue analgesia, and adverse effects. Methodology Forty-eight patients undergoing breast surgery were randomly allocated to either the OFA or OBA group. A thoracic paravertebral block with 0.2% ropivacaine, followed by general anesthesia without opioids, was used in the OFA group. A transdermal fentanyl patch was applied 10 hours before induction of general anesthesia in the OBA group. QoR-15 scores at 24 and 48 hours postoperatively, intraoperative hemodynamic parameters, VAS score for 48 hours, and adverse events were noted. Data was represented as the median and interquartile range (IQR). The Mann-Whitney test was used for continuous variables and Fisher's exact test was used for categorical variables. Results The median (IQR) QoR-15 score was 130 (128-132.75) in the OBA group and 132.5 (132-135) in the OFA group (p = 0.054) at 24 hours and 142 (141-145) in the OBA group vs 145 in the OFA group (140.25-146) (p = 0.367) at 48 hours. QoR-15 in the OFA group had a higher median (IQR) for physical independence, 17.5 (16-18), against 16 (16-17) in the OBA group, with a p-value of 0.016. Four patients in the OBA group had PONV and none in the OFA group (p = 0.037). The comparison of VAS scores and hemodynamic parameters at all the time points was insignificant. Conclusion OFA is similar to OBA, considering the overall quality of recovery according to the QoR-15 score, postoperative analgesia, and intraoperative hemodynamic stability with decreased incidence of PONV.