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Published on: May 26, 2023
Opioid-free anaesthesia protocol based on thoracic paravertebral block enhances postoperative recovery after breast
Panpan Tong1, Ying Guo2, Yun Wang3
1Department of Anesthesiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangdong Esophageal Cancer Institute, Guangzhou 510060, China.
Study Objective:
To evaluate whether the implementation of an opioid-free anaesthesia (OFA) protocol based on thoracic paravertebral block (TPVB) could improve early postoperative recovery quality in patients undergoing breast cancer surgery. We hypothesized that opioid-free anaesthesia with TPVB would improve the 15-item quality of recovery (QoR-15) at 24 h relative to conventional anaesthesia protocol.
Design:
A prospective, randomized and controlled trial.
Setting:
Sun Yat-Sen University Cancer Center and Gansu Provincial Cancer Hospital.
Patients:
Based on a minimal clinically important difference (MCID) of 6.0 and an assumed standard deviation (SD) of 16 for postoperative QoR-15 score, a total of 252 patients undergoing breast cancer surgery were enrolled.
Interventions:
Patients were allocated to either opioid-based anaesthesia (OA) group or OFA group.
Measurements:
The primary outcome was QoR-15 score at 24 h postoperatively. Secondary outcomes included QoR-15 score at 48 h, numerical rating scale (NRS) pain scores at rest and during activity at PACU, 6, 12, 24, and 48 h postoperatively, postoperative analgesic rescue, the occurrence of adverse effects such as nausea and vomiting, the time to first urination and the length of hospital stay.
Main Results:
At 24 h postoperatively, means and standard errors (SE) of QoR-15 score were 139.12 (0.72) in the OFA group significantly higher than those in the OA group 132.48 (0.84) [difference of 6.6, 95 % Confidence Interval (CI), 4.87-8.40, P < 0.001]. The QoR-15 score of OFA [145.31 (0.67)] at 48 h is also higher than that of OA [142.18 (0.88)]. The resting NRS score at 6 h and the active NRS score within 12 h after surgery in the OFA group were significantly lower than those in the OA group (P < 0.001). Fewer patients suffered from postoperative nausea and retching in the OFA group (P < 0.05). There were no statistical differences in the time to first urination and length of stay between OFA and OA groups (P > 0.05).
Conclusion:
OFA based on TPVB improved the postoperative quality of recovery in patients undergoing breast cancer surgery.
Trial Registration:
http://www.chictr.org.cn, Identifier: ChiCTR2300072501, principal investigator: Renchun Lai, date of registration: 2023-06-15.
Clinical Trial Registration:
ChiCTR2300072501.
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