Postoperative Opioid-Free Multistep Opiranserin Infusion Versus Fentanyl Patient-Controlled Analgesia After Breast or Minimally Invasive Gynecologic Surgery: A Retrospective Cohort Study

Background/Objectives: Women undergoing breast or gynecologic surgery face high postoperative nausea and vomiting (PONV) risk, which often prompts discontinuation of opioid patient-controlled analgesia (PCA). Since anticipated opioid use is an Apfel risk factor, we examined a postoperative opioid-free analgesic regimen using opiranserin, previously evaluated only as an adjunct.

Methods

In this single-center retrospective cohort study, 150 women undergoing breast or minimally invasive gynecologic surgery received a multistep opiranserin infusion via a PCA pump without demand boluses (n = 77) or fentanyl demand bolus PCA (n = 73). The opiranserin infusion ended at 10 h; fentanyl PCA remained connected throughout. The primary outcome was resting numeric rating scale (NRS, 0–10) at 24 h, by which time the infusion had been complete for 14–15 h; secondary outcomes were post-anesthesia care unit (PACU) and 6 h NRS, PONV, and early discontinuation.