Background
Modified radical mastectomy (MRM) with axillary clearance of lymph nodes was routinely performed under general anaesthesia with intra- and postoperative opioid analgesia. Recently, there has been a move toward opioid-free anesthesia (OFA) to appreciate the goals of hypnosis with amnesia and sympathetic stability without the adverse effects of opioids.
The primary aims

The secondary aims

Methods
Forty adult female patients scheduled for elective unilateral MRM were randomly divided into two groups (20 patients in each group): OFA and OBA.
Results
There was statistically significant decrease in pain score at rest and on movement in the OFA group. Postoperative nausea and vomiting was significantly decreased in the OFA group ( = 0.04). Patients in the OFA group were more satisfied than those in the OBA group using verbal rating scale for satisfaction ( < 0.001). There was significant low incidence of neuropathic pain in the OFA group; also, we found significant changes in interleukin 10, tumour necrosis factor alpha and caspase 3 between the two groups.
Conclusion
OFA is safe and effective in mastectomy as it decreases the pain score and the incidence of post mastectomy neuropathic pain; moreover, it also shows better immune response postoperatively.