{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:52:33Z","timestamp":1790776353438,"version":"4.1.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Opioid-free anesthesia (OFA) is an emerging technique that aims to reduce or eliminate intraoperative opioid use. Previous studies have shown that OFA is associated with reduced postoperative opioid consumption and fewer adverse events. This study investigated the impact of OFA on the quality of recovery (QoR) in patients undergoing radical mastectomy for breast cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 130 patients scheduled for radical mastectomy and randomly assigned them to either the opioid-free anesthesia (OFA) group or the opioid-based anesthesia (OA) group. Data from 124 patients were ultimately analyzed. The primary outcome was the Quality of Recovery-40 (QoR-40) score at 24 and 48\u00a0h postoperatively. Secondary outcomes included the Numerical Rating Scale (NRS) pain scores at 30\u00a0min, 24\u00a0h, and 48\u00a0h postoperatively, perioperative hemodynamic parameters, post-anesthesia care unit (PACU) stay duration, and the incidence of related adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Postoperative QoR-40 scores were significantly higher in the OFA group than in the OA group at both 24\u00a0h (176.1 \u00b1 3.7 vs 169.7 \u00b1 3.3; mean difference 6.4, 95% CI 5.2\u20137.7,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) and 48\u00a0h (180.3 \u00b1 2.7 vs 173.7 \u00b1 3.6; mean difference 6.6, 95% CI 5.5\u20137.7,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.01). The OFA group showed significantly lower pain scores on the Numeric Rating Scale (NRS) at all measured time points (30\u00a0min: 1.89 \u00b1 0.8 vs 2.36 \u00b1 1.2; 24\u00a0h: 1.21 \u00b1 0.6 vs 1.66 \u00b1 0.8; 48\u00a0h: 1.03 \u00b1 0.4 vs 1.28 \u00b1 0.6, all\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05). No statistically significant differences were observed in hemodynamic parameters, including mean arterial pressure (MAP) and heart rate (HR), at the following time points: upon entering the operating room (T0), before anesthesia induction (T1), before tracheal intubation (T2), immediately after tracheal intubation (T3), at skin incision (T4), 10\u00a0min after incision (T5), and upon leaving the operating room (T6). However, the incidence of postoperative nausea and vomiting (PONV) differed significantly between the two groups at 30\u00a0min, 24\u00a0h, and 48\u00a0h postoperatively (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For patients undergoing radical mastectomy, opioid-free anesthesia (OFA) utilizing esketamine combined with Interpectoral Plane (IPP) and Pectoralis-Serratus Plane (PSP) blocks significantly improved postoperative recovery quality compared to conventional opioid-based anesthesia (OA).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2025.1679423","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:05:29Z","timestamp":1765807529000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Opioid-free anesthesia with esketamine combined with interpectoral plane block and pectoralis-serratus plane blocks in radical mastectomy: a randomized controlled trial"],"prefix":"10.3389","volume":"16","author":[{"given":"Wenping","family":"Ding","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youming","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuo","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongguo","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meiyan","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liwei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1016\/j.jclinane.2018.10.040","article-title":"Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: a prospective, randomized, controlled trial","volume":"54","author":"Alt\u0131parmak","year":"2019","journal-title":"J. Clin. Anesth."},{"key":"B2","doi-asserted-by":"publisher","first-page":"10650","DOI":"10.1136\/rapm-2025-106504","article-title":"Impact of opioid-free general anesthesia with locoregional blocks during breast cancer surgery on systemic inflammatory response: results from a randomized controlled trial","volume":"2025","author":"Brescia","year":"2025","journal-title":"Reg. Anesth. Pain Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.2147\/TCRM.S281572","article-title":"Development and validation of the Chinese version of the quality of recovery-40 questionnaire","volume":"16","author":"Chen","year":"2020","journal-title":"Ther. Clin. Risk Manag."},{"key":"B4","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s12871-023-01994-5","article-title":"Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial","volume":"23","author":"Chen","year":"2023","journal-title":"BMC Anesthesiol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"3049","DOI":"10.1053\/j.jvca.2022.04.028","article-title":"Effect of S-ketamine on postoperative quality of recovery in patients undergoing video-assisted thoracic surgery","volume":"36","author":"Cheng","year":"2022","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e085988","DOI":"10.1136\/bmjopen-2024-085988","article-title":"Safety and effectiveness of multimodal opioid-free anaesthesia for pain and recovery after laparoscopic surgery: a systematic review and meta-analysis","volume":"15","author":"Cheng","year":"2025","journal-title":"BMJ Open"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1466","DOI":"10.1007\/s12630-024-02831-0","article-title":"Opioid-free anesthesia for minimally invasive abdominal surgery: a systematic review, meta-analysis, and trial sequential analysis","volume":"71","author":"Da Silveira","year":"2024","journal-title":"Can. J. Anesthesia\/Journal Can. d\u2019anesth\u00e9sie"},{"key":"B8","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s44158-021-00008-5","article-title":"Opioid-free anesthesia versus opioid-inclusive anesthesia for breast cancer surgery: a retrospective study","volume":"1","author":"Di Benedetto","year":"2021","journal-title":"J. Anesth. Analgesia Crit. Care"},{"key":"B9","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1097\/AJP.0000000000000985","article-title":"Efficacy and safety of pectoral nerve block (pecs) compared with control, paravertebral block, erector spinae plane block, and local anesthesia in patients undergoing breast cancer surgeries: a systematic review and meta-analysis","volume":"37","author":"Elshanbary","year":"2021","journal-title":"Clin. J. Pain"},{"key":"B10","doi-asserted-by":"publisher","first-page":"111215","DOI":"10.1016\/j.jclinane.2023.111215","article-title":"Opioid-free anesthesia: a systematic review and meta-analysis","volume":"90","author":"Feenstra","year":"2023","journal-title":"J. Clin. Anesth."},{"key":"B11","doi-asserted-by":"publisher","first-page":"110691","DOI":"10.1016\/j.jclinane.2022.110691","article-title":"Pectoserratus plane block versus erector spinae plane block for postoperative opioid consumption and acute and chronic pain after breast cancer surgery: a randomized controlled trial","volume":"79","author":"Genc","year":"2022","journal-title":"J. Clin. Anesth."},{"key":"B12","doi-asserted-by":"publisher","first-page":"257","DOI":"10.36076\/ppj.2023.26.257","article-title":"Sub-anesthesia dose of S-ketamine reduces postoperative pain and anxiety in patients receiving breast and thyroid surgery: a randomized, controlled trial","volume":"26","author":"Gong","year":"2023","journal-title":"Pain Physician J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1093\/bja\/aet014","article-title":"Measurement of quality of recovery using the QoR-40: a quantitative systematic review","volume":"111","author":"Gornall","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"B14","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1097\/JS9.0000000000002060","article-title":"Esketamine vs. placebo combined with erector spinae plane block vs. intercostal nerve block on quality of recovery following thoracoscopic lung resection: a randomized controlled factorial trial","volume":"111","author":"Hu","year":"2025","journal-title":"Int. J. Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1016\/j.bpa.2017.05.003","article-title":"Opioid-free anesthesia opioid side effects: tolerance and hyperalgesia","volume":"31","author":"Lavand\u2019homme","year":"2017","journal-title":"Opioid free Anaesth."},{"key":"B16","doi-asserted-by":"publisher","first-page":"3607","DOI":"10.1007\/s00520-017-3824-3","article-title":"Risk factors of pain in breast cancer survivors: a systematic review and meta-analysis","volume":"25","author":"Leysen","year":"2017","journal-title":"Support. Care Cancer"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2833","DOI":"10.2147\/dddt.s513571","article-title":"Effect of different doses of esketamine on postoperative recovery in patients undergoing gynecologic laparoscopic surgery, a randomized, double-blind, single-center clinical study","volume":"19","author":"Li","year":"2025","journal-title":"Drug Des. Dev. Ther."},{"key":"B18","doi-asserted-by":"publisher","first-page":"101453","DOI":"10.1016\/j.accpm.2024.101453","article-title":"Opioid-free anaesthesia and postoperative quality of recovery: a systematic review and meta-analysis with trial sequential analysis","volume":"44","author":"Liu","year":"2025","journal-title":"Anaesth. Crit. Care and Pain Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"110437","DOI":"10.1016\/j.jclinane.2021.110437","article-title":"Impact of opioid-free anaesthesia on postoperative nausea, vomiting and pain after gynaecological laparoscopy\u2014A randomised controlled trial","volume":"75","author":"Massoth","year":"2021","journal-title":"J. Clin. Anesth."},{"key":"B20","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s40981-015-0018-1","article-title":"Pectoral nerve block combined with general anesthesia for breast cancer surgery: a retrospective comparison","volume":"1","author":"Morioka","year":"2015","journal-title":"JA Clin. Rep."},{"key":"B21","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1186\/s12885-025-14277-8","article-title":"Effect of breast cancer surgery on levels of depression and anxiety: a systematic review and meta-analysis","volume":"25","author":"Movahed","year":"2025","journal-title":"BMC Cancer"},{"key":"B22","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1093\/oxfordjournals.bja.a013366","article-title":"Validity and reliability of a postoperative quality of recovery score: the QoR-40","volume":"84","author":"Myles","year":"2000","journal-title":"Br. J. Anaesth."},{"key":"B23","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1097\/ALN.0000000000001158","article-title":"Minimal clinically important difference for three quality of recovery scales","volume":"125","author":"Myles","year":"2016","journal-title":"Anesthesiology"},{"key":"B24","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1111\/anae.14213","article-title":"Combined thoracic paravertebral and pectoral nerve blocks for breast surgery under sedation: a prospective observational case series","volume":"73","author":"Pawa","year":"2018","journal-title":"Anaesthesia"},{"key":"B25","doi-asserted-by":"publisher","first-page":"13","DOI":"10.21037\/joma-22-20","article-title":"Opioid-free anesthesia and opioid-based anesthesia in oral and maxillofacial surgery: a systematic review and meta-analysis of randomized controlled trials","volume":"2","author":"Qi","year":"2023","journal-title":"J. Oral Maxillofac. Anesth."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2069","DOI":"10.3390\/jcm10102069","article-title":"Opioid-free anesthesia benefit\u2013risk balance: a systematic review and meta-analysis of randomized controlled trials","volume":"10","author":"Salom\u00e9","year":"2021","journal-title":"J. Clin. Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.2147\/jpr.s197669","article-title":"Combined ultrasound-guided Pecs II block and general anesthesia are effective for reducing pain from modified radical mastectomy","volume":"12","author":"Senapathi","year":"2019","journal-title":"J. Pain Res."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.4103\/ija.ija_8_20","article-title":"Comparison of pectoralis plane blocks with ketamine-dexmedetomidine adjuncts and opioid-based general anaesthesia in patients undergoing modified radical mastectomy","volume":"64","author":"Shah","year":"2020","journal-title":"Indian J. Anaesth."},{"key":"B29","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s44158-025-00272-9","article-title":"Effectiveness and safety of opioid-free anesthesia compared to opioid-based anesthesia: a systematic review and network meta-analysis","volume":"5","author":"Tripodi","year":"2025","journal-title":"J. Anesth. Analg. Crit. Care"},{"key":"B30","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1111\/anae.14607","article-title":"Analgesic efficacy of the Pecs II block: a systematic review and meta\u2010analysis","volume":"74","author":"Versyck","year":"2019","journal-title":"Anaesthesia"},{"key":"B31","doi-asserted-by":"publisher","first-page":"111823","DOI":"10.1016\/j.jclinane.2025.111823","article-title":"Opioid-free anesthesia for quality of recovery score after surgery: a meta-analysis of randomized controlled trials","volume":"103","author":"Wang","year":"2025","journal-title":"J. Clin. Anesth."},{"key":"B32","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1186\/s12871-023-02357-w","article-title":"The ED50 and ED95 of esketamine for preventing early postoperative pain in patients undergoing laparoscopic cholecystectomy: a prospective, double-blinded trial","volume":"23","author":"Xu","year":"2023","journal-title":"BMC Anesthesiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1186\/s12893-024-02518-9","article-title":"Opioid-free anesthesia with esketamine-dexmedetomidine versus opioid-based anesthesia with propofol-remifentanil in shoulder arthroscopy: a randomized controlled trial","volume":"24","author":"Xue","year":"2024","journal-title":"BMC Surg."},{"key":"B34","doi-asserted-by":"publisher","first-page":"3157","DOI":"10.2147\/JPR.S380354","article-title":"Effects of esketamine combined with ultrasound-guided pectoral nerve block type II on the quality of early postoperative recovery in patients undergoing a modified radical mastectomy for breast cancer: a randomized controlled trial","volume":"15","author":"Yu","year":"2022","journal-title":"J. Pain Res."},{"key":"B35","doi-asserted-by":"publisher","first-page":"4291","DOI":"10.2147\/DDDT.S392784","article-title":"Effects of the different doses of esketamine on postoperative quality of recovery in patients undergoing modified radical mastectomy: a randomized, double-blind, controlled trial","volume":"16","author":"Zhu","year":"2022","journal-title":"Drug Des. Dev. Ther."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1679423\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T14:05:30Z","timestamp":1765807530000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2025.1679423\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":35,"alternative-id":["10.3389\/fphar.2025.1679423"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2025.1679423","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,25]]},"article-number":"1679423"}}