Open AccessArticle Effect of Opioid-Sparing Anesthesia on Postoperative Nausea and Vomiting After Breast Surgery: A Single-Center Randomized Controlled Trial by Tae-Yun Sung Tae-Yun Sung SciProfiles Scilit Preprints.org Google Scholar Tae-Yun Sung, MD, PhD, is a Professor in the Department of Anesthesiology and Pain Medicine, Konyang [...] Read more 1, Youngjin Kim Youngjin Kim SciProfiles Scilit Preprints.org Google Scholar 2 and Ji-Yoon Jung Ji-Yoon Jung SciProfiles Scilit Preprints.org Google Scholar 1,* 1 Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University Myunggok Medical Research Institute, Konyang University College of Medicine, Daejeon 35365, Republic of Korea 2 Department of General Surgery, Konyang University Hospital, Daejeon 35365, Republic of Korea * Author to whom correspondence should be addressed. J. Clin. Med. 2026, 15(12), 4459; https://doi.org/10.3390/jcm15124459 (registering DOI) Submission received: 12 May 2026 / Revised: 5 June 2026 / Accepted: 8 June 2026 / Published: 9 June 2026 Abstract Background/Objectives: Postoperative nausea and vomiting (PONV) remain frequent after breast surgery despite prophylaxis. This single-center, parallel-group randomized controlled trial evaluated whether intraoperative opioid-sparing anesthesia using dexmedetomidine and lidocaine reduced 48 h PONV compared with opioid-based anesthesia. Methods: Adult women undergoing elective breast surgery were randomized 1:1 to opioid-sparing anesthesia with dexmedetomidine and lidocaine or conventional opioid-based anesthesia with remifentanil. Participants and postoperative outcome assessors were blinded to group allocation; attending anesthesiologists were not blinded. All patients received standardized sevoflurane anesthesia, dexamethasone, ramosetron, quantitative neuromuscular monitoring, and postoperative fentanyl patient-controlled analgesia. The primary outcome was PONV within 48 h after surgery. Results: Among 68 randomized patients, 67 were analyzed (opioid-sparing group, n = 33; control group, n = 34). PONV within 48 h occurred in 8 patients (24.2%) in the opioid-sparing group and 28 patients (82.4%) in the control group (risk ratio, 0.29; 95% confidence interval, 0.16–0.55; p < 0.001; absolute risk reduction, 58.1%; number needed to treat, 1.7). Rescue antiemetic use was lower in the opioid-sparing group in the postanesthesia care unit and at 1 h postoperatively. Pain scores and cumulative opioid consumption were comparable. No Clavien–Dindo grade III or higher complications occurred. Conclusions: Intraoperative opioid-sparing anesthesia was associated with lower 48 h PONV after breast surgery without apparent compromise in analgesia. These single-center findings, from a trial registered after enrollment of one participant, require confirmation in larger prospectively registered multicenter trials. Trial Registration: Clinical Research Information Service (CRIS), KCT0009829. Registered on 10 October 2024. From a perioperative clinical perspective, PONV is a modifiable outcome that can affect patient comfort, early recovery, and healthcare resource use. Strategies that reduce opioid-related adverse effects while preserving analgesia are therefore relevant to contemporary perioperative care pathways. Intraoperative opioid administration is a modifiable contributor to PONV. Opioids promote nausea and vomiting through central effects on the chemoreceptor trigger zone and area postrema and through peripheral effects on gastrointestinal motility and gastric emptying [ 6, 7]. These adverse effects have led to increasing interest in multimodal anesthetic strategies that reduce intraoperative opioid exposure while maintaining analgesic adequacy. We conducted a prospective, single-center randomized controlled trial to evaluate whether an intraoperative opioid-sparing regimen using dexmedetomidine and lidocaine reduces the incidence of PONV within 48 h after breast surgery compared with opioid-based anesthesia. We hypothesized that intraoperative opioid sparing would reduce PONV without increasing postoperative pain or opioid consumption. 2. Materials and Methods 2.1. Study Design and Participants This prospective, single-center, randomized controlled trial was conducted at Konyang University Hospital, Daejeon, Republic of Korea, between October 2024 and November 2025. The study protocol was approved by the Institutional Review Board of Konyang University Hospital on 29 July 2024 (approval no. KYUH 2024-07-006), and written informed consent was obtained from all participants before enrollment. The trial was conducted in accordance with the Declaration of Helsinki and reported according to the CONSORT 2025 statement. The trial was registered with the Clinical Research Information Service (CRIS; registration no. KCT0009829) on 10 October 2024. At the time of trial registration, one participant had already been enrolled. No changes were made to the eligibility criteria, interventions, outcome definitions, assessment time points, or statistical analysis plan after trial registration, and no protocol deviations occurred after registration. Eligible participants were women aged 19–75 years with American Society of Anesthesiologists physical status I–III who were scheduled for elective breast surgery under general anesthesia. Exclusion criteria were planned same-day discharge, expected postoperative mechanical ventilation, reoperation within 48 h after surgery, contraindications to any study medication, psychiatric illness or cognitive dysfunction, chronic opioid use, inability to provide informed consent, or refusal to participate. Baseline risk factors for PONV, including smoking status and a history of PONV or motion sickness, were recorded to calculate the simplified Apfel risk score for each patient [ 2 2.2. Randomization and Blinding Participants were randomly assigned in a 1:1 ratio to either the conventional opioid-based anesthesia group or the opioid-sparing anesthesia group. The randomization sequence was generated using R software, version 3.6.3 (R Foundation for Statistical Computing, Vienna, Austria) with a fixed seed, using simple randomization without blocking or stratification. Group assignments were concealed using sequentially numbered, opaque, sealed envelopes, which were opened immediately before induction of anesthesia. Because of the nature of the intervention, the attending anesthesiologists could not be blinded. However, participants, postanesthesia care unit (PACU) nurses, and ward staff responsible for postoperative outcome assessment were blinded to group allocation. 2.3. Anesthesia and Perioperative Management All participants received standard monitoring, including electrocardiography, noninvasive blood pressure monitoring, and pulse oximetry. Nitrous oxide was not used. Oxygen was administered via face mask before induction. Dexamethasone 5 mg was administered intravenously at induction for antiemetic prophylaxis, followed by propofol 1.5–2.0 mg/kg and rocuronium 0.6 mg/kg. Neuromuscular blockade was confirmed as a train-of-four count of zero using a quantitative neuromuscular monitoring device (TwitchView, Blink Device Company, Seattle, WA, USA). Endotracheal intubation was performed after loss of consciousness and adequate neuromuscular blockade. Depth of anesthesia was continuously monitored using a SedLine brain function monitor (Masimo Corp., Irvine, CA, USA). In the conventional opioid-based anesthesia group, remifentanil was administered by target-controlled infusion starting at an effect-site concentration of 3 ng/mL and was titrated in increments of 0.5 ng/mL according to systolic blood pressure. Remifentanil was continued throughout surgery and discontinued at skin closure. In both groups, anesthesia was maintained with sevoflurane adjusted to maintain a SedLine index of 25–50. Neuromuscular blockade was maintained with intermittent rocuronium boluses and reversed at the end of surgery with sugammadex according to quantitative neuromuscular monitoring. Ramosetron 0.3 mg was administered intravenously at the end of surgery. All participants received intravenous patient-controlled analgesia (PCA) containing fentanyl at a total prescribed dose of 20 μg/kg. The PCA was programmed as a 2 mL demand bolus with a 10 min lockout interval and no basal infusion. Actual fentanyl consumption was calculated from recorded PCA use and the patient-specific fentanyl concentration. During the first postoperative hour in the PACU, fentanyl 1 μg/kg was used as rescue analgesia, and dexamethasone 5 mg or metoclopramide 10 mg was used as rescue antiemetic therapy as needed. After PACU discharge, postoperative pain and PONV were managed on the ward according to a standardized institutional protocol until postoperative day 2. Nonopioid analgesics, including acetaminophen or nonsteroidal anti-inflammatory drugs when not contraindicated, were used as first-line rescue analgesics. Tramadol or intravenous fentanyl was reserved for inadequate pain control. Rescue antiemetics included metoclopramide or dexamethasone according to clinician assessment and institutional practice. 2.4. Outcomes The primary outcome was the incidence of PONV within 48 h after surgery. PONV was assessed at four predefined time points: on arrival in the PACU, 1 h after PACU admission, postoperative day 1, and postoperative day 2. Nausea was recorded as patient-reported nausea, and vomiting was defined as any episode of retching or expulsion of gastric contents. Assessments were performed by PACU nurses and ward staff who were unaware of group allocation, using a standardized checklist. Rescue antiemetic therapy was administered when patients reported nausea, experienced retching or vomiting, or requested treatment for nausea. A formal numerical nausea severity scale was not used. Antiemetics were not administered preemptively after surgery in the absence of nausea, retching, vomiting, or patient request. These criteria were applied according to a standardized institutional checklist by PACU nurses and ward staff who were blinded to group allocation. Secondary outcomes included rescue antiemetic use, cumulative antiemetic dose through postoperative day 2, cumulative intravenous PCA consumption through postoperative day 1 and postoperative day 2, additional postoperative analgesic requirements, postoperative pain scores assessed using the numeric rating scale through postoperative day 2, and complications classified as Clavien-Dindo grade III or higher. Minor adverse events were identified from the anesthetic record and postoperative chart when clinically documented or when active treatment was required. 2.5. Statistical Analysis The primary and secondary outcomes were analyzed in all randomized participants for whom outcome data were available. Categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Continuous variables were compared using Student’s t test or the Mann–Whitney U test according to data distribution. For the primary outcome, effect estimates were expressed as risk ratios with 95% confidence intervals (CIs), along with absolute risk reduction and number needed to treat. Because of the modest sample size and limited number of outcome events, adjusted analyses were considered exploratory. A parsimonious logistic regression model was used to estimate the association between group allocation and PONV after adjustment for the prespecified baseline PONV risk measure, the Apfel score. Additional covariates were not included in the primary adjusted model to reduce the risk of overfitting. A supplementary model including clinically relevant covariates was performed as a sensitivity analysis and is presented as exploratory. All analyses were performed using R software. A two-sided p-value < 0.05 was considered statistically significant. Sample Size Calculation The sample size was calculated based on an institutional PONV incidence of 70% after breast surgery. A 50% relative reduction was considered clinically meaningful. Using G*Power version 3.1, with a two-sided α of 0.05 and power of 80%, 31 participants were required per group. Assuming a dropout rate of 10%, 34 participants per group were enrolled, for a total sample size of 68. 3. Results 3.1. Patient Flow and Baseline Characteristics A total of 78 patients were assessed for eligibility. Six patients were excluded because of psychiatric illness or cognitive dysfunction, and four declined to participate. Consequently, 68 patients were randomized to either the opioid-sparing anesthesia group or the conventional opioid-based anesthesia group. One patient in the opioid-sparing group had incomplete 48 h follow-up data; therefore, outcome analyses were performed in 67 patients (opioid-sparing group, n = 33; control group, n = 34) (). Baseline demographic and clinical characteristics were comparable between groups ( and Supplementary Table S1). Intraoperative variables, including anesthesia duration, propofol dose, vasoactive agent use, estimated blood loss, and crystalloid administration, were also similar between groups ( Supplementary Table S2). 3.2. Primary Outcome PONV within 48 h occurred in 8 patients (24.2%) in the opioid-sparing group and 28 patients (82.4%) in the control group ( p < 0.001; and A). This corresponded to an absolute risk reduction of 58.1% (95% CI, 36–74%), a risk ratio of 0.29 (95% CI, 0.16–0.55), and an odds ratio of 0.07 (95% CI, 0.02–0.23). The number needed to treat was 1.7. 3.3. Secondary Outcomes and Adverse Events Rescue antiemetic use was lower in the opioid-sparing group than in the control group in the PACU (12.1% vs. 50.0%, p = 0.001) and at 1 h postoperatively (15.2% vs. 67.6%, p < 0.001; B). Postoperative pain scores did not differ significantly between groups at any time point. Cumulative opioid consumption over 48 h was numerically lower in the opioid-sparing group than in the control group (median [interquartile range], 288 [204–374] μg vs. 303.5 [232–407.5] μg), but the difference was not statistically significant ( p = 0.22). Rescue analgesic requirements were similar between groups. No Clavien–Dindo grade III or higher complications occurred in either group. Minor adverse events were rare and included one case of transient bradycardia in the opioid-sparing group and one case of transient hypertension in the control group. 3.4. Exploratory Adjusted Analysis In the parsimonious exploratory logistic regression model adjusted for Apfel score, opioid-sparing anesthesia remained associated with a lower risk of PONV (adjusted odds ratio, 0.07; 95% CI, 0.02–0.25; p < 0.001). A broader exploratory model including age, body mass index, American Society of Anesthesiologists physical status, and duration of anesthesia yielded similar point estimates but should be interpreted cautiously because of the limited number of events (). The broader exploratory model is visualized in . 4. Discussion In this single-center randomized trial, an intraoperative opioid-sparing regimen using dexmedetomidine and lidocaine was associated with a lower incidence of PONV within 48 h after breast surgery than opioid-based anesthesia. This reduction was observed despite standardized antiemetic prophylaxis and postoperative fentanyl PCA use in both groups. Postoperative pain scores, rescue analgesic use, and cumulative opioid consumption were not significantly different between groups. The mechanisms underlying this association are likely multifactorial. Opioids can promote nausea and vomiting through central μ-opioid receptor effects in the area postrema and chemoreceptor trigger zone and through delayed gastric emptying and impaired gastrointestinal motility [ 6, 7, 16]. Remifentanil has an ultrashort context-sensitive half-time, but intraoperative exposure may still influence early postoperative nausea through opioid receptor activation, postoperative opioid sensitivity, and opioid-induced hyperalgesia or enhanced nociceptive signaling in some settings [ 7, 24]. Dexmedetomidine may reduce sympathetic activation and opioid requirements and has been associated with reduced PONV in perioperative studies [ 17, 18]. Intravenous lidocaine may improve postoperative recovery and gastrointestinal function and can reduce nociceptive input [ 19, 20]. Therefore, the observed effect may reflect both avoidance of intraoperative remifentanil and pharmacologic effects of the nonopioid adjuncts. An important feature of this study is that postoperative opioid exposure was not eliminated. Both groups received fentanyl-based PCA, and cumulative postoperative opioid consumption did not differ significantly. Therefore, the intervention should be understood as an intraoperative opioid-sparing anesthetic regimen rather than a fully opioid-free perioperative pathway. The substantial difference in PONV despite similar postoperative PCA use suggests that intraoperative opioid exposure may be particularly relevant for early PONV in this setting. However, this interpretation remains hypothesis-generating because the study was not designed to isolate the independent effects of remifentanil avoidance, dexmedetomidine, or lidocaine. The adjusted analysis also requires caution. In the original model including multiple covariates, the direction and magnitude of the treatment effect were similar, although the number of outcome events was limited. For this reason, the adjusted analysis was revised to a parsimonious exploratory model adjusted only for the Apfel score, and the broader model is presented as a sensitivity analysis. The unadjusted risk ratio, absolute risk reduction, and number needed to treat remain the most transparent estimates of the primary outcome. This study has several strengths. The randomized design reduces selection bias, and group allocation was concealed. Outcome assessment was performed by PACU and ward staff who were unaware of group allocation. The anesthetic protocol was standardized, neuromuscular monitoring was quantitative, nitrous oxide was not used, and both groups received the same antiemetic prophylaxis and postoperative PCA regimen. These features reduce several potential confounders relevant to PONV. Several limitations should be acknowledged. First, this was a single-center study with a modest sample size, which limits generalizability and precision. Second, simple randomization without blocking or stratification may be suboptimal in small trials, although baseline characteristics were comparable between groups. Third, anesthesiologists could not be blinded, which may have introduced performance bias. Fourth, trial registration was completed after enrollment had begun because of an administrative delay; however, only one participant had been enrolled before registration. No changes were made to the eligibility criteria, interventions, outcome definitions, assessment time points, or statistical analysis plan after trial registration, and no protocol deviations occurred after registration. Fifth, all patients received postoperative fentanyl PCA; therefore, this study does not evaluate a fully opioid-free perioperative pathway. Sixth, the study population consisted exclusively of women undergoing breast surgery, limiting applicability to male patients or surgical populations with lower baseline PONV risk. Finally, we did not assess patient-centered recovery measures such as the quality of recovery score. In this single-center randomized trial, intraoperative opioid-sparing anesthesia using dexmedetomidine and lidocaine was associated with a lower incidence of PONV within 48 h after breast surgery than opioid-based anesthesia, without apparent compromise in postoperative analgesia. Given the modest sample size, trial registration after enrollment of one participant, postoperative fentanyl use in both groups, and the single-center design, these findings should be interpreted cautiously and warrant confirmation in larger, prospectively registered multicenter trials before routine adoption. Supplementary Materials The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/jcm15124459/s1: Table S1: Detailed underlying diseases and medication use; Table S2: Intraoperative characteristics. Author Contributions T.-Y.S.: Conceptualization, methodology, validation, resources, formal analysis, data curation, and writing—original draft. Y.K.: Data curation, validation, visualization, software, and writing—review and editing. J.-Y.J.: Conceptualization, methodology, validation, resources, formal analysis, software, supervision, and writing—review and editing. All authors have read and agreed to the published version of the manuscript. Funding This work was supported by the Research Settlement Fund for the New Faculty of Konyang University Hospital. Institutional Review Board Statement The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Konyang University Hospital on 29 July 2024 (approval no. KYUH 2024-07-006). Informed Consent Statement Informed consent was obtained from all subjects involved in the study. Written informed consent for publication was not required because this manuscript does not contain identifiable individual patient data. Data Availability Statement The datasets generated and/or analyzed during the current study are not publicly available because they contain potentially identifiable clinical information but are available from the corresponding author upon reasonable request and with appropriate ethical approval. Conflicts of Interest The authors declare no conflicts of interest. The funder had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. Abbreviations The following abbreviations are used in this manuscript: ALND Axillary lymph node dissection ASA American Society of Anesthesiologists CI Confidence interval CRIS Clinical Research Information Service NRS Numeric rating scale PACU Postanesthesia care unit PCA Patient-controlled analgesia PONV Postoperative nausea and vomiting RCT Randomized controlled trial SLNB Sentinel lymph node biopsy References Qian, Y.; Zhu, J.K.; Hou, B.L.; Sun, Y.E.; Gu, X.P.; Ma, Z.L. Risk factors of postoperative nausea and vomiting following ambulatory surgery: A retrospective case-control study. Heliyon 2022, 8, e12430. [ Google Scholar] [ CrossRef] [ PubMed] Apfel, C.C.; Läärä, E.; Koivuranta, M.; Greim, C.A.; Roewer, N. 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A total of 78 patients were assessed for eligibility; 68 were randomized, and 67 were included in the final analysis (opioid-sparing anesthesia group, n = 33; control group, n = 34). Flowchart of patient enrollment, exclusions, and allocation. A total of 78 patients were assessed for eligibility; 68 were randomized, and 67 were included in the final analysis (opioid-sparing anesthesia group, n = 33; control group, n = 34). Incidence of postoperative nausea and vomiting (PONV) and rescue antiemetic use. ( A) Incidence of PONV within 48 h after surgery. ( B) Proportion of patients requiring rescue antiemetics in the postanesthesia care unit (PACU) and at 1 h postoperatively. Error bars represent 95% confidence intervals. Incidence of postoperative nausea and vomiting (PONV) and rescue antiemetic use. ( A) Incidence of PONV within 48 h after surgery. ( B) Proportion of patients requiring rescue antiemetics in the postanesthesia care unit (PACU) and at 1 h postoperatively. Error bars represent 95% confidence intervals. Exploratory adjusted predictors of postoperative nausea and vomiting (PONV). Logistic regression results are presented as adjusted odds ratios with 95% confidence intervals on a logarithmic scale. The vertical solid line indicates an odds ratio of 1.0. Exploratory adjusted predictors of postoperative nausea and vomiting (PONV). Logistic regression results are presented as adjusted odds ratios with 95% confidence intervals on a logarithmic scale. The vertical solid line indicates an odds ratio of 1.0. Baseline demographic and preoperative characteristics. Baseline demographic and preoperative characteristics. Variable Opioid-Sparing Anesthesia Group ( n = 33) Control Group ( n = 34) p Value Age, years ୫୬.୧ ବ୍ଦ ୯.୧ ୫୩.୨ ବ୍ଦ ୧୧.୧ 0.23 Height, cm 158.4 [153.0–160.0] 158.5 [155.0–162.0] 0.72 Weight, kg 55.2 [48.1–63.4] 59.3 [55.2–63.6] 0.11 Body mass index, kg/m 222.4 [19.4–25.4] 23.8 [21.4–25.4] 0.11 History of PONV 3 (9.1%) 3 (8.8%) 0.95 Apfel score 0.96 3 30 (90.9%) 31 (91.2%) 4 3 (9.1%) 3 (8.8%) ASA physical status 0.81 I 0 (0.0%) 1 (2.9%) II 28 (84.8%) 28 (82.4%) III 5 (15.2%) 5 (14.7%) Hypertension 6 (18.2%) 9 (26.5%) 0.60 Diabetes mellitus 4 (12.1%) 2 (5.9%) 0.42 Diagnosis 0.44 Ductal carcinoma in situ 0 (0.0%) 3 (8.8%) Intraductal papilloma 1 (3.0%) 1 (2.9%) Malignant neoplasm of breast 31 (94.0%) 29 (85.4%) Microcalcification 1 (3.0%) 1 (2.9%) Surgery 0.62 Modified radical mastectomy 10 (30.3%) 15 (44.1%) Partial mastectomy 1 (3.0%) 0 (0.0%) Partial mastectomy with ALND 19 (57.6%) 16 (47.1%) Partial mastectomy with SLNB 2 (6.1%) 1 (2.9%) Total mastectomy 1 (3.0%) 2 (5.9%) Values are expressed as mean ± SD, median [interquartile range], or number of patients (%). ASA, American Society of Anesthesiologists; ALND, axillary lymph node dissection; PONV, postoperative nausea and vomiting; SLNB, sentinel lymph node biopsy. Primary and secondary postoperative outcomes. Primary and secondary postoperative outcomes. Outcome Opioid-Sparing Anesthesia Group ( n = 33) Control Group ( n = 34) p Value Primary outcome PONV within 48 h 8 (24.2%) 28 (82.4%) <0.001 Secondary outcomes Postoperative antiemetic use in PACU 0.001 None 29 (87.9%) 17 (50.0%) Dexamethasone 4 (12.1%) 15 (44.1%) Metoclopramide 0 (0.0%) 2 (5.9%) Postoperative antiemetic use at 1 h <0.001 None 28 (84.8%) 11 (32.4%) Dexamethasone 3 (9.1%) 6 (17.6%) Metoclopramide 2 (6.1%) 17 (50.0%) Postoperative antiemetic use at 24 h 0.51 None 33 (100.0%) 32 (94.1%) Metoclopramide 0 (0.0%) 2 (5.9%) Postoperative pain score (NRS) PACU 2.0 [2.0–3.0] 3.0 [2.0–3.0] 0.13 1 h postoperatively 3.0 [2.0–3.0] 3.0 [3.0–3.0] 0.32 24 h postoperatively 3.0 [2.0–3.0] 3.0 [2.0–3.0] 0.93 48 h postoperatively 2.0 [2.0–3.0] 2.0 [2.0–3.0] 0.72 Maximum NRS score 3.0 [3.0–4.0] 3.0 [3.0–4.0] 0.34 Postoperative PCA consumption, mL 1 h postoperatively 32.0 [30.0–36.0] 36.0 [33.0–40.0] 0.09 1–24 h postoperatively 150.0 [108.0–204.0] 150.0 [130.0–255.0] 0.11 24–48 h postoperatively 78.0 [55.0–144.0] 84.0 [70.0–120.0] 0.62 Postoperative analgesic use in PACU 0.95 None 31 (93.9%) 32 (94.1%) Nonopioid 2 (6.1%) 2 (5.9%) Postoperative analgesic use at 1 h 0.94 None 31 (93.9%) 30 (88.3%) Nonopioid 2 (6.1%) 3 (8.8%) Opioid 0 (0.0%) 1 (2.9%) Postoperative analgesic use at 24 h 0.72 None 23 (69.7%) 20 (58.8%) Nonopioid 2 (6.1%) 2 (5.9%) Opioid 8 (24.2%) 12 (35.3%) Postoperative analgesic use at 48 h 0.95 None 32 (97.0%) 33 (97.1%) Nonopioid 0 (0.0%) 1 (2.9%) Opioid 1 (3.0%) 0 (0.0%) Cumulative opioid consumption over 48 h, fentanyl equivalents (μg) 288.0 [204.0–374.0] 303.5 [232.0–407.5] 0.22 Values are expressed as median [interquartile range] or number of patients (%). NRS, numeric rating scale; PACU, postanesthesia care unit; PCA, patient-controlled analgesia; PONV, postoperative nausea and vomiting. No statistical comparison was performed when there was no variability between groups. Exploratory logistic regression analysis for postoperative nausea and vomiting. Exploratory logistic regression analysis for postoperative nausea and vomiting. Model and Variable Odds Ratio 95% CI p Value Parsimonious exploratory model Opioid-sparing anesthesia vs. control 0.07 0.02–0.25 <0.001 Apfel score, per point 6.00 0.65–142 0.13 Broader sensitivity model Opioid-sparing anesthesia vs. control 0.07 0.02–0.23 <0.001 Apfel score, per point 6.32 0.65–152 0.15 Age, per year 0.99 0.92–1.07 0.84 Body mass index, kg/m 21.05 0.89–1.26 0.55 ASA physical status, per class 1.83 0.28–12.5 0.52 Duration of anesthesia, per min 1.01 0.99–1.03 0.40 The parsimonious model was prespecified for the revised analysis to reduce overfitting and included group allocation and the Apfel score. The broader model is presented only as a sensitivity analysis and should be interpreted cautiously because of the limited number of outcome events. ASA, American Society of Anesthesiologists; CI, confidence interval. 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Effect of Opioid-Sparing Anesthesia on Postoperative Nausea and Vomiting After Breast Surgery: A Single-Center Randomized Controlled Trial. Journal of Clinical Medicine. 2026; 15(12):4459. https://doi.org/10.3390/jcm15124459 Chicago/Turabian Style Sung, Tae-Yun, Youngjin Kim, and Ji-Yoon Jung. 2026. "Effect of Opioid-Sparing Anesthesia on Postoperative Nausea and Vomiting After Breast Surgery: A Single-Center Randomized Controlled Trial" Journal of Clinical Medicine 15, no. 12: 4459. https://doi.org/10.3390/jcm15124459 APA Style Sung, T.-Y., Kim, Y., & Jung, J.-Y. (2026). Effect of Opioid-Sparing Anesthesia on Postoperative Nausea and Vomiting After Breast Surgery: A Single-Center Randomized Controlled Trial. Journal of Clinical Medicine, 15(12), 4459. https://doi.org/10.3390/jcm15124459 Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here. 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