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

Pain Res Manag. 2021 Nov 17:2021:3290289. doi: 10.1155/2021/3290289. eCollection 2021.

Abstract

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.

MeSH terms

  • Analgesia*
  • Analgesics / therapeutic use
  • Analgesics, Opioid / therapeutic use
  • Breast Neoplasms* / complications
  • Breast Neoplasms* / surgery
  • Double-Blind Method
  • Female
  • Humans
  • Ketamine* / therapeutic use
  • Morphine / therapeutic use
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / etiology
  • Prospective Studies

Substances

  • Analgesics
  • Analgesics, Opioid
  • Ketamine
  • Morphine