Characteristics of included studies (n = 17).

BackgroundBreast 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.MethodsFollowing 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.ResultsSeventeen 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).ConclusionOSA 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.背景：乳腺癌是女性最常见的恶性肿瘤，患者术后需快速过渡至辅助治疗。阿片类药物麻醉（Opioid-based anesthesia, OBA）应用广泛，但存在术后恶心呕吐（postoperative nausea and vomiting, PONV）、免疫抑制与痛觉过敏等风险，可能延缓康复进程。阿片节俭麻醉（Opioid-sparing anesthesia, OSA）与无阿片麻醉（Opioid-free anesthesia, OFA）或可降低上述风险，但二者对术后康复质量（Quality of Recovery, QoR）的影响尚不明确。本研究采用贝叶斯网络meta分析，比较三种麻醉策略对乳腺癌手术患者术后早期康复质量的影响。 方法：本研究遵循PRISMA指南（PROSPERO注册号：CRD420251065588），于PubMed、Cochrane图书馆、EMBASE及Web of Science数据库建库起至2025年6月1日开展系统检索。纳入标准为针对成人乳腺癌手术、对比OSA、OFA与OBA且报告康复质量评分的随机对照试验（randomized controlled trials, RCTs）。采用Cochrane偏倚风险工具与GRADE系统评估偏倚风险与证据质量。使用R软件包gemtc进行贝叶斯随机效应分析。连续性数据以均数差（mean difference, MD）报告，分类数据以比值比（odds ratio, OR）报告。 结果：共纳入17项随机对照试验，涉及1254例患者。贝叶斯网络meta分析结果显示，术后24小时康复质量维度上，OSA显著优于OBA（d=0.050，95% CrI：0.038~0.062；SUCRA=85.3%），OFA亦优于OBA（d=0.044，95%CrI：0.020~0.068；SUCRA=64.7%）；OSA与OFA间未观察到显著差异（d=-0.006，95%CrI：-0.029~0.018）。次要结局的SUCRA排名显示，OFA在控制术后恶心呕吐（99.4%）与疼痛管理（81.4%）方面表现最优，而OSA在情绪健康（96.2%）与躯体舒适感（76.6%）维度更具优势。在躯体独立性方面，OFA（85.1%）优于OSA（63.5%），而在心理支持维度无显著组间差异。术中阿片类药物使用剂量与康复质量提升呈倒U型关联（p=0.0004）。 结论：OSA是提升乳腺癌手术患者术后24小时整体康复质量的最优麻醉策略。尽管OFA在减少术后恶心呕吐与疼痛控制方面表现突出，但OSA在多维度康复质量上的获益更为均衡。临床推荐采用个体化麻醉方案，以阿片类药物最小化而非完全消除为目标。