scholarly journals Opioid-free anesthesia versus opioid-inclusive anesthesia for breast cancer surgery: a retrospective study

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Pia Di Benedetto ◽  
Massimiliano Pelli ◽  
Chiara Loffredo ◽  
Rosaria La Regina ◽  
Federico Policastro ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Satisfaction ◽  
Retrospective Study ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Postoperative Nausea And Vomiting ◽  
Numeric Rating Scale ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Anesthetic Technique

Abstract Background Breast 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). Results A 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. Conclusions A 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.

scholarly journals Prevention of Acute Postoperative Pain in Breast Cancer: A Comparison between Opioids versus Ketamine in the Intraoperatory Analgesia

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Mirian López ◽  
María Luz Padilla ◽  
Blas García ◽  
Javier Orozco ◽  
Ana María Rodilla
Keyword(s):  
Breast Cancer ◽  
Postoperative Pain ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Opioid Use ◽  
Acute Postoperative Pain ◽  
Systemic Side Effects ◽  
Waking Up

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.

scholarly journals Effects of Intraoperative Low-Dose Ketamine on Persistent Postsurgical Pain after Breast Cancer Surgery: A Prospective, Randomized, Controlled, Double-Blind Study

2020 ◽  
Vol 1;23 (1;1) ◽  
pp. 37-47
Author(s):  
Ah-Reum Cho
Keyword(s):  
Breast Cancer ◽  
Study Design ◽  
Low Dose ◽  
Rating Scale ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Control Group ◽  
Double Blind Study ◽  
Postsurgical Pain ◽  
Number Of Patients

Background: Compared to acute postsurgical pain, studies regarding the role of ketamine in persistent postsurgical pain (PPSP) are limited. Objectives: The aim of this clinical trial was to test if intraoperative low-dose ketamine without postoperative infusion would reduce PPSP development after breast cancer surgery. Study design: We used a randomized, double-blinded, placebo study design. Setting: This study was conducted at Pusan National University Hospital, Republic of Korea, between December 2013 and August 2016. Methods: A total of 184 patients scheduled for breast cancer surgery were randomly assigned to either the control or ketamine group. Before skin incision, a bolus (0.5 mg/kg of ketamine or placebo), followed by a continuous infusion (0.12 mg/kg/h of ketamine or placebo), was administered until the end of the surgery. The patients were interviewed via telephone 1, 3, and 6 months after surgery. The first question was whether the patient had surgery-related pain. If answered affirmatively, questions from the Numeric Rating Scale for pain at rest (NRSr) and for coughing (NRSd) were also asked. Our primary outcome was the incidence of PPSP at 3 months after surgery. Results: For PPSP analysis, 168 patients were included. The number of patients who experienced pain was significantly lower in the ketamine group at 3 months (86.9% in the control group vs 69.0% in the ketamine group, P = .005) postoperatively. However, the NRSr and NRSd did not differ between the groups throughout the follow-up. Limitations: There were no postoperative low-dose ketamine infusion groups to compare due to hospital regulations. Dosage of ketamine was too low to reduce the severity of PPSP. And by using propofol and remifentanil for anesthesia, different results can be deduced with volatile anesthetics. Data from written questionnaires would have been more specific than telephone interviews for long-term assessment. Conclusions: Though intraoperative low-dose ketamine without postoperative infusion significantly reduced the incidence of PPSP up to 3 months after breast cancer surgery, it failed to reduce clinically significant PPSP and improve patients’ quality of life. Key words: Analgesia, breast cancer, chronic pain, ketamine, mastectomy, morphine, pain, postoperative, propofol

scholarly journals Patient satisfaction after breast cancer surgery

2020 ◽  
Author(s):  
Carmen Leser ◽  
Yen Y. Tan ◽  
Christian Singer ◽  
Robert Zeillinger ◽  
Florian Fitzal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Patient Satisfaction ◽  
Cancer Surgery ◽  
Breast Cancer Surgery

scholarly journals Influence of the Phase of Menstrual Cycle on Postoperative Nausea and Vomiting after Breast Cancer Surgery

2018 ◽  
Vol 41 (1) ◽  
pp. 19
Author(s):  
Jong Wha Lee ◽  
Jun Seop Lee ◽  
Jong Hak Kim ◽  
Youn Jin Kim ◽  
Jae Hee Woo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Menstrual Cycle ◽  
Postoperative Nausea ◽  
Postoperative Nausea And Vomiting ◽  
Cancer Surgery ◽  
Nausea And Vomiting ◽  
Breast Cancer Surgery
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