Postoperative Analgesia Impact of Narcotic Free Anesthesia (PAINFree)

• Pain level in recovery room [ Time Frame: immediately after surgery ] [ Designated as safety issue: No ]
• Occurence of nausea and vomiting in the recovery room [ Time Frame: immediately after surgery ] [ Designated as safety issue: No ]
• Time spent in recovery room [ Time Frame: immediately after surgery ] [ Designated as safety issue: No ]
• Chronic post-surgical pain [ Time Frame: 3 and 6 months ] [ Designated as safety issue: No ]
• Reccurence of breast cancer [ Time Frame: 5 years ] [ Designated as safety issue: No ]

The first hypothesis of the study is that substituting fentanyl by esmolol and metoprolol during general anesthesia for patients undergoing mastectomy will result in less pain and less narcotic consumption in the recovery room. The investigators will also verify the impact of that substitution on nausea and vomiting, on the time spent in the recovery room and on chronic postsurgical pain (3 and 6 months).

Finally, the investigators will see the impact on breast cancer recurrence 5 years after the surgery.

• Pain, Postoperative
• Breast Cancer
• Postoperative Nausea and Vomiting

• Drug: fentanyl
  Use of esmolol and metoprolol compared to use of fentanyl for hemodynamic control during general anesthesia. At induction, fentanyl (2 mcg/kg) is replaced by esmolol (1 mg/kg). During the case, with a standardised anesthesia, response to surgical stimulation will be medicated either by fentanyl (50 mcg aliquot) or metropolol (2.5 mg), for a maximum of 6 doses. After this, fentanyl will be given unblindly.
• Drug: beta-blocker (esmolol, metropolol)
  esmolol is used at induction and lopressor during surgery instead of fentanyl in response to surgical stimulation.

• Active Comparator: fentanyl
  Intervention: Drug: fentanyl
• Experimental: beta-blocker
  Instead of narcotics (fentanyl), esmolol and lopressor are being used for hemodynamic control
  Intervention: Drug: beta-blocker (esmolol, metropolol)

Inclusion Criteria:

• Woman
• 18 to 65 years old
• ASA 1 or 2
• First breast surgery
• Unilateral breast cancer
• Partial mastectomy or radical modified mastectomy ± axillary dissection

Exclusion Criteria:

• Allergy or contrindication to any medication figuring in the protocol or to Aspirin
• Patient taking betablocking drug drug or lanoxin or calcic channels blocking drug
• Narcotic consumption in the past month of 10 mg/day of morphine equivalent
• Chronic pain
• Moderate to severe asthma
• BMI of more than 40
• Diabetes
• Chronic renal or hepatic faiure
• Heart failure
• Anticipated difficult airway
• High grade heart block or bifascicular block
• Mental retardation