{"title":"无阿片麻醉联合胸神经阻滞对乳房切除术后患者恢复质量的影响：随机对照试验。","authors":"Jiawei Chen, Lewei He, Yuying Shi, Jing Jiao, Shaoqiang Huang, Jianhua Zhou, Qingyan Luo","doi":"10.1371/journal.pone.0320592","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of opioid-free anesthesia (OFA) combined with regional blocks on the quality of recovery (QoR) in patients who underwent mastectomy.</p><p><strong>Methods: </strong>This randomized controlled trial involved 132 mastectomy patients who were randomized to receive either OFA combined with PECS block or opioid-based anesthesia (OBA) combined with PECS block. The QoR was assessed using the QoR-15 global score at 24 h post-surgery. Secondary outcomes included postoperative sufentanil consumption, incidence of postoperative nausea and vomiting (PONV), Numerical Rating Scale (NRS) scores at 1, 4, and 24 h, incidence of postoperative adverse events, extubation, incidence of severe bradycardia and intraoperative mean artrial pressure (MAP) and heart rate (HR) at after entering the operating room (T0, baseline value), after intubation (T1), after skin incision (T2), and after extubation (T3).</p><p><strong>Results: </strong>The QoR-15 global score at 24 h was not significantly different between groups (MD = -0.4, 95% CI [-3.8 to 4.7], P = 0.67). Postoperative sufentanil consumptions (P = 0.075), the incidence of PONV (P = 0.12), NRS scores at 1 h (P = 0.36), 4 h (P = 0.53), and 24 h (P = 0.02) were not significantly different. Incidence of adverse events (OR = 0, 95% CI [0 to 0.44], P = 0.0063) were lower in Group OFA than that in Group OBA. Extubation time was significantly longer in Group OFA than in Group OBA (MD = 15, 95%CI [10-18], P < 0.001). MAPs at T1 and T2 were significantly higher in Group OFA than in Group OBA (P < 0.0125), while MAP and HR at T3 were significantly lower in Group OFA than in Group OBA(P < 0.0125). Incidence of severe bradycardia were not significantly different (P = 0.67).</p><p><strong>Conclusion: </strong>In conclusion, while OFA contributes to a reduction in adverse events, its integration with PECS blocks does not improve QoR or postoperative analgesia at 24 h post-mastectomy. Moreover, OFA was associated with a prolonged extubation time.</p><p><strong>Trial registration: </strong>chictr.org; registration number: ChiCTR2100043575.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"20 4","pages":"e0320592"},"PeriodicalIF":2.6000,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967923/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effect of opioid-free anesthesia combined with pectoral nerve block on the quality of recovery in patients after mastectomy: A randomized, controlled trial.\",\"authors\":\"Jiawei Chen, Lewei He, Yuying Shi, Jing Jiao, Shaoqiang Huang, Jianhua Zhou, Qingyan Luo\",\"doi\":\"10.1371/journal.pone.0320592\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To evaluate the impact of opioid-free anesthesia (OFA) combined with regional blocks on the quality of recovery (QoR) in patients who underwent mastectomy.</p><p><strong>Methods: </strong>This randomized controlled trial involved 132 mastectomy patients who were randomized to receive either OFA combined with PECS block or opioid-based anesthesia (OBA) combined with PECS block. The QoR was assessed using the QoR-15 global score at 24 h post-surgery. Secondary outcomes included postoperative sufentanil consumption, incidence of postoperative nausea and vomiting (PONV), Numerical Rating Scale (NRS) scores at 1, 4, and 24 h, incidence of postoperative adverse events, extubation, incidence of severe bradycardia and intraoperative mean artrial pressure (MAP) and heart rate (HR) at after entering the operating room (T0, baseline value), after intubation (T1), after skin incision (T2), and after extubation (T3).</p><p><strong>Results: </strong>The QoR-15 global score at 24 h was not significantly different between groups (MD = -0.4, 95% CI [-3.8 to 4.7], P = 0.67). Postoperative sufentanil consumptions (P = 0.075), the incidence of PONV (P = 0.12), NRS scores at 1 h (P = 0.36), 4 h (P = 0.53), and 24 h (P = 0.02) were not significantly different. Incidence of adverse events (OR = 0, 95% CI [0 to 0.44], P = 0.0063) were lower in Group OFA than that in Group OBA. Extubation time was significantly longer in Group OFA than in Group OBA (MD = 15, 95%CI [10-18], P < 0.001). MAPs at T1 and T2 were significantly higher in Group OFA than in Group OBA (P < 0.0125), while MAP and HR at T3 were significantly lower in Group OFA than in Group OBA(P < 0.0125). Incidence of severe bradycardia were not significantly different (P = 0.67).</p><p><strong>Conclusion: </strong>In conclusion, while OFA contributes to a reduction in adverse events, its integration with PECS blocks does not improve QoR or postoperative analgesia at 24 h post-mastectomy. Moreover, OFA was associated with a prolonged extubation time.</p><p><strong>Trial registration: </strong>chictr.org; registration number: ChiCTR2100043575.</p>\",\"PeriodicalId\":20189,\"journal\":{\"name\":\"PLoS ONE\",\"volume\":\"20 4\",\"pages\":\"e0320592\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-04-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967923/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"PLoS ONE\",\"FirstCategoryId\":\"103\",\"ListUrlMain\":\"https://doi.org/10.1371/journal.pone.0320592\",\"RegionNum\":3,\"RegionCategory\":\"综合性期刊\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"MULTIDISCIPLINARY SCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"PLoS ONE","FirstCategoryId":"103","ListUrlMain":"https://doi.org/10.1371/journal.pone.0320592","RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"MULTIDISCIPLINARY SCIENCES","Score":null,"Total":0}
引用次数: 0
摘要
目的：探讨无阿片类药物麻醉（OFA）联合局部阻滞对乳房切除术患者恢复质量的影响。方法：本随机对照试验纳入132例乳房切除术患者，随机接受OFA联合PECS阻滞或阿片类药物麻醉（OBA）联合PECS阻滞。术后24小时采用QoR-15整体评分评估QoR。次要结局包括术后舒芬太尼用量、术后恶心呕吐发生率（PONV）、1、4、24 h数值评定量表（NRS）评分、术后不良事件发生率、拔管发生率、严重心动过慢发生率、术中平均到达压（MAP）和心率（HR）在进入手术室后（T0，基线值）、插管后（T1）、皮肤切开后（T2）和拔管后（T3）。结果：24 h QoR-15整体评分组间差异无统计学意义（MD = -0.4, 95% CI [-3.8 ~ 4.7], P = 0.67）。术后舒芬太尼用量（P = 0.075）、PONV发生率（P = 0.12）、1 h （P = 0.36）、4 h （P = 0.53）、24 h (P = 0.02) NRS评分差异无统计学意义。OFA组不良事件发生率（OR = 0, 95% CI [0 ~ 0.44], P = 0.0063）低于OBA组。OFA组拔管时间明显长于OBA组（MD = 15, 95%CI [10-18], P < 0.001）。OFA组T1、T2时MAP显著高于OBA组（P < 0.0125）， T3时MAP、HR显著低于OBA组（P < 0.0125）。两组严重心动过缓发生率无显著差异（P = 0.67）。结论：虽然OFA有助于减少不良事件，但其与PECS阻滞的结合并不能改善乳房切除术后24小时的QoR或术后镇痛。此外，OFA与拔管时间延长有关。试验注册：chictr.org；注册号：ChiCTR2100043575。
Effect of opioid-free anesthesia combined with pectoral nerve block on the quality of recovery in patients after mastectomy: A randomized, controlled trial.
Objective: To evaluate the impact of opioid-free anesthesia (OFA) combined with regional blocks on the quality of recovery (QoR) in patients who underwent mastectomy.
Methods: This randomized controlled trial involved 132 mastectomy patients who were randomized to receive either OFA combined with PECS block or opioid-based anesthesia (OBA) combined with PECS block. The QoR was assessed using the QoR-15 global score at 24 h post-surgery. Secondary outcomes included postoperative sufentanil consumption, incidence of postoperative nausea and vomiting (PONV), Numerical Rating Scale (NRS) scores at 1, 4, and 24 h, incidence of postoperative adverse events, extubation, incidence of severe bradycardia and intraoperative mean artrial pressure (MAP) and heart rate (HR) at after entering the operating room (T0, baseline value), after intubation (T1), after skin incision (T2), and after extubation (T3).
Results: The QoR-15 global score at 24 h was not significantly different between groups (MD = -0.4, 95% CI [-3.8 to 4.7], P = 0.67). Postoperative sufentanil consumptions (P = 0.075), the incidence of PONV (P = 0.12), NRS scores at 1 h (P = 0.36), 4 h (P = 0.53), and 24 h (P = 0.02) were not significantly different. Incidence of adverse events (OR = 0, 95% CI [0 to 0.44], P = 0.0063) were lower in Group OFA than that in Group OBA. Extubation time was significantly longer in Group OFA than in Group OBA (MD = 15, 95%CI [10-18], P < 0.001). MAPs at T1 and T2 were significantly higher in Group OFA than in Group OBA (P < 0.0125), while MAP and HR at T3 were significantly lower in Group OFA than in Group OBA(P < 0.0125). Incidence of severe bradycardia were not significantly different (P = 0.67).
Conclusion: In conclusion, while OFA contributes to a reduction in adverse events, its integration with PECS blocks does not improve QoR or postoperative analgesia at 24 h post-mastectomy. Moreover, OFA was associated with a prolonged extubation time.
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