A Comparative Analysis of Opioid-Based Anesthesia (OBA) and Opioid-Free Anesthesia (OFA) in Modified Radical Mastectomy: Effect on Hemodynamics Changes Intraoperative, Inflammatory Cytokine (IL-6) Levels, Pain Degree, and Postoperative Opioid Requirements

Achmad Yusuf Toba; Syafruddin Gaus; Andi Muhammad  Takdir Musba; Muhammad Ramli Ahmad; Alamsyah A. A. Husain; Madonna D. Datu

doi:10.18502/aacc.v12i3.21313

Achmad Yusuf Toba Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Syafruddin Gaus Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Andi Muhammad Takdir Musba Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Muhammad Ramli Ahmad Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Alamsyah A. A. Husain Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.
Madonna D. Datu Department of Anesthesia, Intensive Care and Pain Management, Hasanuddin University, Makassar, Indonesia.

DOI: https://doi.org/10.18502/aacc.v12i3.21313

Keywords: Opioid-based anesthesia; Opioid-free anesthesia; Modified radical mastectomy; Interleukin-6 levels; Postoperative pain

Abstract

Background: Acute postoperative pain following modified radical mastectomy (MRM) remains a significant clinical problem, affecting patients’ quality of life. Opioid-based anesthesia (OBA), while effective for analgesia, is associated with adverse effects, including increased interleukin-6 (IL-6) levels, and the higher the IL-6 levels, the higher the likelihood of breast cancer recurrence. Opioid-free anesthesia (OFA) has emerged as a potential alternative to mitigate these effects. This study aimed to compare the impact of OBA and OFA on intraoperative hemodynamic stability, IL-6 levels, postoperative pain degree, and total postoperative opioid requirements.

Methods: This was a single-blind randomized clinical trial involving 30 patients undergoing MRM, allocated into two groups: Group I received OBA, and Group II received OFA. Parameters assessed included intraoperative hemodynamic changes, serum IL-6 levels, postoperative pain degree, and total postoperative opioid requirements.

Results: The OFA group had significantly lower IL-6 levels at 24 hours post-surgery. The OFA group also demonstrated more stable intraoperative hemodynamics, significantly lower postoperative pain degree, and reduced postoperative opioid (fentanyl) requirements compared to the OBA group.

Conclusion: OFA is better than OBA in modified radical mastectomy surgery. OFA significantly reduced IL-6 levels as a marker of inflammation, resulted in lower recurrence of breast cancer, reduced the degree of postoperative pain, maintained hemodynamic stability during the procedure, and reduced postoperative opioid requirements. These findings suggest that OFA is a more effective and safe anesthetic option in controlling pain and surgical stress response.