{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T23:44:08Z","timestamp":1789256648648,"version":"build-2803163510"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T00:00:00Z","timestamp":1743638400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>\nObjective\n<\/jats:title>\n<jats:p>To evaluate the impact of opioid-free anesthesia (OFA) combined with regional blocks on the quality of recovery (QoR) in patients who underwent mastectomy.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>\nMethods\n<\/jats:title>\n<jats:p>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\u2009h 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\u2009h, 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).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>\nResults\n<\/jats:title>\n<jats:p>The QoR-15 global score at 24\u2009h was not significantly different between groups (MD\u2009=\u2009-0.4, 95% CI [-3.8 to 4.7], <jats:italic>P<\/jats:italic>\u2009=\u20090.67). Postoperative sufentanil consumptions (<jats:italic>P<\/jats:italic>\u2009=\u20090.075), the incidence of PONV (<jats:italic>P<\/jats:italic>\u2009=\u20090.12), NRS scores at 1 h (<jats:italic>P<\/jats:italic>\u2009=\u20090.36), 4 h (<jats:italic>P<\/jats:italic>\u2009=\u20090.53), and 24\u2009h (<jats:italic>P<\/jats:italic>\u2009=\u20090.02) were not significantly different. Incidence of adverse events (OR\u2009=\u20090, 95% CI [0 to 0.44], <jats:italic>P<\/jats:italic>\u2009=\u20090.0063) were lower in Group OFA than that in Group OBA. Extubation time was significantly longer in Group OFA than in Group OBA (MD\u2009=\u200915, 95%CI [10\u201318], <jats:italic>P<\/jats:italic> &lt; \u20090.001). MAPs at T1 and T2 were significantly higher in Group OFA than in Group OBA (<jats:italic>P<\/jats:italic> &lt; \u20090.0125), while MAP and HR at T3 were significantly lower in Group OFA than in Group OBA(<jats:italic>P<\/jats:italic> &lt; \u20090.0125). Incidence of severe bradycardia were not significantly different (<jats:italic>P<\/jats:italic>\u2009=\u20090.67).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>\nConclusion\n<\/jats:title>\n<jats:p>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\u2009h post-mastectomy. Moreover, OFA was associated with a prolonged extubation time.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>\nTrial registration\n<\/jats:title>\n<jats:p>chictr.org; registration number: ChiCTR2100043575.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0320592","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T19:24:25Z","timestamp":1743708265000},"page":"e0320592","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effect of opioid-free anesthesia combined with pectoral nerve block on the quality of recovery in patients after mastectomy: A randomized, controlled trial"],"prefix":"10.1371","volume":"20","author":[{"given":"Jiawei","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewei","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuying","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Jiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoqiang","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5792-8668","authenticated-orcid":true,"given":"Qingyan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,3]]},"reference":[{"issue":"2","key":"pone.0320592.ref001","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/bjs.7331","article-title":"Evidence-based review of enhancing postoperative recovery after breast surgery","volume":"98","author":"R Arsalani-Zadeh","year":"2011","journal-title":"Br J Surg"},{"key":"pone.0320592.ref002","doi-asserted-by":"crossref","first-page":"110274","DOI":"10.1016\/j.jclinane.2021.110274","article-title":"Comparison of local and regional anesthesia modalities in breast surgery: A systematic review and network meta-analysis","volume":"72","author":"H-Y Wong","year":"2021","journal-title":"J Clin Anesth"},{"issue":"10","key":"pone.0320592.ref003","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1007\/s12630-022-02295-0","article-title":"Association of peripheral nerve blocks with patient-reported quality of recovery in female patients receiving breast cancer surgery: a systematic review and meta-analysis of randomized controlled studies","volume":"69","author":"K-C Hung","year":"2022","journal-title":"Can J Anaesth"},{"issue":"5","key":"pone.0320592.ref004","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1111\/anae.14582","article-title":"Analgesic impact of intra-operative opioids vs. opioid-free anaesthesia: a systematic review and meta-analysis","volume":"74","author":"J Frauenknecht","year":"2019","journal-title":"Anaesthesia"},{"issue":"6","key":"pone.0320592.ref005","doi-asserted-by":"crossref","first-page":"439","DOI":"10.23736\/S0375-9393.22.15850-5","article-title":"Effect of opioid-free anesthesia on postoperative analgesia after laparoscopic gynecologic surgery","volume":"88","author":"J Chen","year":"2022","journal-title":"Minerva Anestesiol"},{"key":"pone.0320592.ref006","doi-asserted-by":"crossref","first-page":"109689","DOI":"10.1016\/j.jclinane.2019.109689","article-title":"Quality of recovery after non opioid versus opioid anesthesia for spinal surgery: A prospective observational study","volume":"61","author":"E Ursulet","year":"2020","journal-title":"J Clin Anesth"},{"issue":"1","key":"pone.0320592.ref007","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s12871-021-01561-w","article-title":"Combined opioid free and loco-regional anaesthesia enhances the quality of recovery in sleeve gastrectomy done under ERAS protocol: a randomized controlled trial","volume":"22","author":"M Ibrahim","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"pone.0320592.ref008","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.2147\/JPR.S373412","article-title":"The Effect of Opioid-Free Anesthesia on the Quality of Recovery After Gynecological Laparoscopy: A Prospective Randomized Controlled Trial","volume":"15","author":"H Choi","year":"2022","journal-title":"J Pain Res"},{"issue":"4","key":"pone.0320592.ref009","first-page":"183","article-title":"Opioid-free anesthesia: what about patient comfort? 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