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Abstract
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Background and Aims Acute perioperative pain, if not managed adequately, can result in chronic pain. Opioid-free anesthesia (OFA) is a combination of multimodal analgesia without the use of opioids. Chronic postsurgical pain may lead to functional limitations and psychological trauma for patients. In our study; we aimed to assess the efficacy of erector spinae block (ESP) without opioids versus opioid-based anesthesia in patients undergoing breast cancer surgery. We followed them up at 6 months to find out if the anesthetic technique made any difference in the development of chronic pain in these patients.
Methods 100 patients undergoing breast cancer surgery were randomized into two groups in 1:1 ratio. Group O received opioid-based anesthesia and Group N received ultrasound guided ESP block without any opioids intraoperatively. Post-extubation analgesia was managed with a patient-controlled analgesia pump containing morphine. Our primary outcome was 24-hour morphine consumption. Secondary outcomes included NRS at various time points postoperatively (1,2,6,24 hour) and at 6 months.
Results There was no statistical difference in the total 24-hour postoperative morphine consumption (p=0.13). The NRS at 6 months differed significantly, with group N having a lower score (4.72±2.2 vs 2.56± 1.41; p<0.05). NRS at rest and on movement at various time points postoperatively did not differ significantly (p>0.05).
Conclusions Our follow-up data found that Opioid free was associated with decreased chronic pain at 6 months and can be considered as a technique of choice in oncology surgeries.
Box and whisker plot showing the NRS at 6 months postoperatively in group O and N