少阿片类药物麻醉与无阿片类药物麻醉对乳腺癌手术患者术后恢复质量的影响：系统回顾与网状Meta分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：王婷婷          编辑：王波          审校：曹莹


背景
背景jbhb

乳腺癌是女性中最常见的恶性肿瘤，患者在手术后需要迅速转至辅助治疗阶段。基于阿片类药物的麻醉（OBA）被广泛应用，但存在术后恶心呕吐（PONV）、免疫抑制和痛觉过敏等风险，这些可能会延缓恢复。阿片类药物节省型麻醉（OSA）和无阿片类药物麻醉（OFA）或许能降低这些风险，但它们对术后恢复质量（QoR）的影响尚不明确。本研究采用贝叶斯网络荟萃分析，比较了这三种麻醉策略对乳腺癌手术后早期恢复质量（QoR）的影响。

方法


本按照PRISMA指南（PROSPERO ID: CRD420251065588），系统检索PubMed、Cochrane Library、EMBASE和Web of Science数据库，检索时间从建库至2025年6月1日。纳入比较OSA、OFA和OBA在成人乳腺癌手术中的随机对照试验（rct），并报告QoR评分。采用Cochrane系统评价工具和GRADE系统对纳入文献进行偏倚风险和证据质量评价。使用R软件包gemtc进行贝叶斯随机效应分析。连续数据报告为平均差，分类数据报告为比值比。

结果


共纳入17项rct， 1 254例患者。贝叶斯网络meta分析，OSA组术后24 h QoR明显优于OBA组与OBA组相比，OFA组的治疗效果更好（d=0.044, 95% CrI: 0.020 ~ 0.068； SUCRA=64.7%）。无显著差异，OSA组与OFA组间差异有统计学意义（d=−0.006,95% CrI:−0.029 ~ 0.018）。次要结果SUCRA显示OFA在控制术后恶心呕吐（99.4%）和疼痛管理（81.4%）方面最有效，而OSA在情绪健康（96.2%）和身体舒适度（76.6%）方面最有效。在生理独立方面，OFA（85.1%）优于OSA(63.5%)，而在心理独立方面差异无统计学意义支持。术中阿片类药物减少呈倒u型关系QoR改善（p=0.0004）。

【罂粟摘要】少阿片类药物麻醉与无阿片类药物麻醉对乳腺癌手术患者术后恢复质量的影响：系统回顾与网状Meta分析

结论


      OSA是提高乳腺癌术后24 h内整体恢复质量的最佳策略。虽然OFA在减少PONV和控制疼痛方面表现出色，但OSA在多个QoR维度上提供了更平衡的益处。建议采用个体化麻醉方法，目的是尽量减少阿片类药物，而不是完全消除阿片类药物。

原始文献来源：Liu J, Liu J, Wang M, Wang X. Opioid-sparing anesthesia versus opioid-free anesthesia for postoperative recovery quality in breast cancer surgery patients: A systematic review and Bayesian network meta-analysis. PLoS One. 2025;20(10):e0334614. Published 2025 Oct 24. doi:10.1371/journal.pone.0334614

Opioid-sparing anesthesia versus opioid-free

anesthesia for postoperative recovery quality in breast cancer surgery patients: A systematic review and Bayesian network meta-analysis

Background Breast cancer is the most common malignancy among women, and patients require rapid transition to adjuvant therapy post-surgery. Opioid-based anesthesia (OBA) is widely used but carries risks such as postoperative nausea and vomiting (PONV), immunosuppression, and hyperalgesia, which may delay recovery. Opioid-sparing anesthesia (OSA) and opioid-free anesthesia (OFA) may reduce these risks, but their effects on postoperative quality of recovery (QoR) are unclear. This study compares the effects of these three anesthetic strategies on early postoperative QoR in breast cancer surgery using a Bayesian network meta-analysis.

Methods  Following PRISMA guidelines (PROSPERO ID: CRD420251065588), a systematic search was conducted in PubMed, Cochrane Library, EMBASE, and Web of Science from inception to June 1, 2025. Included were randomized controlled trials (RCTs) comparing OSA, OFA, and OBA in adult breast cancer surgery that reported QoR scores. Risk of bias and evidence quality were assessed using the Cochrane tool and GRADE system. Bayesian random-effects analysis was performed with the R package gemtc. Continuous data were reported as mean differences, and categorical data as odds ratios..

Results Seventeen RCTs with 1,254 patients were included. Bayesian network meta-analysis showed that OSA significantly outperformed OBA in 24-hour postoperative QoR (d=0.050, 95% CrI: 0.038–0.062; SUCRA=85.3%), and OFA was also superior to OBA (d=0.044, 95% CrI: 0.020–0.068; SUCRA=64.7%). No significant difference was found between OSA and OFA (d=−0.006, 95% CrI: −0.029–0.018). Secondary outcomes SUCRA showed that OFA was most effective in controlling postoperative nausea and vomiting (99.4%) and pain management (81.4%), while OSA excelled in emotional well-being (96.2%) and physical comfort (76.6%). For physical independence, OFA (85.1%) outperformed OSA (63.5%), with no differences in psychological support. Intraoperative opioid reduction showed an inverted U-shaped relationship with QoR improvement (p=0.0004).

Conclusion OSA is the optimal strategy for enhancing overall quality of recovery within 24 hours after breast cancer surgery. Although OFA excels in PONV reduction and pain control, OSA offers more balanced benefits across multiple QoR dimensions. An individualized anesthetic approach is recommended, aiming for opioid minimization rather than complete elimination.

END