Recovery quality with regional anesthesia and dexmedetomidine sedation versus general anesthesia for ambulatory breast cancer surgery: A randomized trial

BACKGROUND: Advances in regional anesthesia techniques and the widespread use of ultrasound guidance have enabled safe and effective anesthesia for ambulatory breast cancer surgery, eliminating the general anesthesia-associated systemic effects. We therefore compared regional anesthesia with dexmedetomidine sedation to general anesthesia on the 15-item postoperative quality of recovery (QoR-15). METHODS: Ninety-six patients scheduled for breast-conserving surgery and sentinel lymph node biopsy were randomly assigned to regional anesthesia with sedation or general anesthesia. In patients assigned to regional anesthesia, a 0.3% ropivacaine solution was used for pectoral and intercostal nerve blocks, followed by a dexmedetomidine infusion. In other patients, standardized general anesthesia was maintained with a laryngeal mask airway. The primary outcome was the QoR-15 score 6 h after surgery. Secondary outcomes included QoR-15 scores at 2 and 24 h; pain scores obtained using the numerical rating scale (NRS) at 2, 6, and 24 h; and the incidence of postoperative complications. RESULTS: At postoperative hour 6, QoR-15 scores were significantly and meaningfully higher in patients given regional anesthesia [142 (136, 146)] than those assigned to general anesthesia [132 (127, 135), p < 0.01]. Regional anesthesia patients also had significantly higher QoR-15 scores at 2 and 24 h postoperatively. Two hours after surgery, regional anesthesia patients had lower pain scores at rest and during movement, needed less rescue analgesia [13 (27%) versus 27 (56%), p < 0.01], and had fewer experienced nausea and vomiting [1 (2%) versus 13 (27%), p < 0.01]. Moreover, patients assigned to regional anesthesia had fewer episodes of hypotension and smaller hemodynamic fluctuations during skin incision. In contrast, there were no significant differences in the incidences of postoperative hypotension and bradycardia in patients randomized to regional and general anesthesia. CONCLUSIONS: Recovery quality after breast-conserving surgery combined with sentinel lymph node biopsy was better with regional anesthesia combined with dexmedetomidine sedation than with general anesthesia. Regional anesthesia also improved pain control, intraoperative hemodynamic stability, and decreased nausea and vomiting.