From the Guidelines
Opioid-free anesthesia is associated with lower postoperative opioid consumption and adverse postoperative events, including reduced postoperative nausea and vomiting.
Postoperative Complications
- Reduced postoperative opioid consumption: Opioid-free anesthesia has been shown to reduce postoperative opioid consumption, which can lead to a decrease in opioid-related complications such as respiratory depression, constipation, and addiction 1.
- Lower incidence of postoperative nausea and vomiting: Studies have found that opioid-free anesthesia is associated with a lower incidence of postoperative nausea and vomiting, which can improve patient comfort and reduce the need for antiemetic medications 1.
- Potential for reduced postoperative pain intensity: The use of alternative analgesics such as ketamine, lidocaine, and magnesium in opioid-free anesthesia may help reduce postoperative pain intensity, although more research is needed to confirm this benefit 1.
Alternative Analgesics
- Ketamine: Ketamine has been shown to reduce postoperative analgesic consumption and pain intensity, particularly in preoperative opioid users 1.
- Lidocaine: Continuous infusion of lidocaine has been studied as a potential alternative to opioids for postoperative pain management 1.
- Magnesium: Perioperative magnesium has been shown to reduce postoperative pain and opioid consumption 1.
- Alpha-2 adrenergic agonists: Clonidine and dexmedetomidine have been found to reduce postoperative opioid use, pain intensity, and nausea 1.
From the Research
Postoperative Complications Associated with Opioid-Free Anesthesia
- The use of opioid-free anesthesia has been shown to reduce adverse postoperative events, mainly driven by decreased nausea and vomiting 2.
- Opioid-free anesthesia can improve postoperative outcomes in several surgical settings without evidence of adverse effects on patient safety and pain management 2.
- However, some studies have found no significant difference in postoperative recovery outcomes between opioid-free anesthesia and opioid-sparing anesthesia under a multimodal analgesic protocol 3.
- Opioid-free multimodal general anesthesia is feasible but did not decrease the incidence of postoperative nausea and vomiting (PONV), or reduce pain scores and morphine consumption compared to an opioid-containing anesthetic regimen 4.
Reduction in Opioid-Related Side Effects
- Opioid-free anesthesia has been shown to reduce the incidence of PONV, with a relative risk of 0.46 (0.38,0.56) in the post-anesthesia care unit (PACU) 5.
- The use of opioid-free anesthesia has also been associated with less sedation and shivering, with a standardized mean difference of -0.81 (-1.05, -0.58) and a relative risk of 0.48 (0.33,0.70), respectively 5.
- However, opioid-free anesthesia may not provide clinically significant benefits in terms of pain and opioid use after surgery 5.
Hemodynamic Stability and Adverse Events
- Opioid-free anesthesia has been shown to facilitate the maintenance of more stable hemodynamics throughout the operation, with a lower incidence of respiratory depression and a reduced need for vasoactive drugs 6.
- However, severe side effects have been identified in the literature, and more data on the safe use of opioid-free anesthesia should be collected 5.
- The incidence of adverse events, such as intraoperative hypotension and bradycardia, was more frequent in the opioid-free anesthesia group, but the differences were not statistically significant 3.