Document Type

Article

Publication Title

Frontiers in Anesthesiology

Abstract

Background: Opioid-free anesthesia (OFA) is a multimodal strategy to avoid intraoperative opioids and minimize associated complications, though evidence remains variable.

Methods: A systematic search of PubMed and Google Scholar (2010–2025), supplemented by AI tools (Google Gemini) for earlier publications, summarized eligible studies (RCTs, cohorts, systematic reviews, and meta-analyses) comparing OFA to opioid-based anesthesia (OBA). Data were summarized following PRISMA-ScR guidelines.

Results: Across 23 randomized controlled trials and one cohort study, OFA consistently reduced PONV, while demonstrating analgesia and recovery outcomes comparable to OBA. Hemodynamic stability was variable, with dexmedetomidine-based OFA regimens sometimes associated with increased bradycardia and hypotension. PACU stay varied, ranging from 9 min shorter to 15–35 min longer with OFA. Long-term outcome data are limited.

Conclusion: OFA is a feasible approach that significantly reduces PONV while maintaining comparable analgesia and recovery. However, heterogeneous protocols, small sample sizes, and scarce long-term data limit external validity. Large, multicenter trials are needed to standardize OFA protocols and clarify long-term outcomes.

DOI

10.3389/fanes.2025.1714040

Publication Date

11-3-2025

Keywords

opioid-free anesthesia (OFA), multimodal analgesia, enhanced recovery after surgery (ERAS), postoperative pain, non-opioid analgesics, opioid crisis

ISSN

2813-480X

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