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Opioid-free anaesthesia protocol based on thoracic paravertebral block enhances postoperative recovery after breast cancer surgery: A two-center, prospective, randomized, controlled trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: 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.

Source: Journal of Clinical Anesthesia

DOI: 10.1016/j.jclinane.2025.111904