INTRODUCTION: Potent analgesics such as sufentanil and remifentanil play a pivotal role in general anesthesia, but these medications have disadvantages, including respiratory depression, nausea, vomiting, immune system suppression, and gastrointestinal function inhibition. This study aimed to evaluate the effects of the transversus thoracic muscle plane-pectoral nerves (TTP-PECS) block on postoperative analgesia, immune function and early postoperative recovery quality in patients undergoing modified radical mastectomy under opioid-sparing general anesthesia. METHODS: A total of 100 patients scheduled for modified radical mastectomy under general anesthesia were randomly divided into the TTP-PECS block combined with opioid-sparing general anesthesia group (TO group, n = 50) or the conventional general anesthesia group (GA group, n = 50). The TO group underwent TTP-PECS block prior to induction, using oxycodone as the analgesic during induction instead of sufentanil, no additional continuous infusion of analgesic was performed intra-operatively. Visual analogue scale (VAS) scores at rest and during movement at different time points were recorded in both groups, and the levels of T cell subsets, natural killer (NK) cells were measured before the surgery and at 24 h and 48 h after the surgery. Quality of Recovery-40 (QoR-40) scores were assessed at 24 h postoperatively, and the incidence of peri-operative adverse reactions was also observed in both groups. RESULTS: Except for 48 h postoperatively, patients in the TO group had significantly lower VAS scores than those in the GA group at 2 h, 6 h, 12 h, and 24 h postoperatively at rest and during movement (P <
0.05). At 24 h and 48 h postoperatively, the expression of CD4 CONCLUSIONS: The combination of TTP-PECS block and oxycodone-propofol opioid-sparing general anesthesia can provide superior postoperative analgesia and reduce the incidence of postoperative nausea and vomiting. It also alleviated the suppression of cellular immune function and improves the quality of early recovery in breast cancer patients. At the same time, opioid-sparing general anesthesia is a safe strategy for modified radical mastectomy. TRIAL REGISTRATION: Chinese Clinical Trial Registry
ChiCTR2200066753.