Pain Physician. 2026 May;29(3):E139-E149.
ABSTRACT
BACKGROUND: Opioid-free anesthesia (OFA) is becoming increasingly common, yet its effects on early postoperative recovery remain unclear.
OBJECTIVE: Our study assessed the effect of OFA on postoperative recovery compared to opioid-based anesthesia (OBA).
STUDY DESIGN: Systematic review and meta-analysis.
METHODS: We searched MEDLINE, the Cochrane Library, Embase, BIOSIS, and Web of Science concluding on December 19, 2024, for randomized controlled trials comparing OFA and OBA in adults (≥ 18 years). Data were extracted, and risk of bias was assessed using the Cochrane RoB 2.0 tool (The Nordic Cochrane Centre for The Cochrane Collaboration). The primary outcome was recovery quality at postoperative 24 hours. Random-effects meta-analyses were conducted. Evidence certainty was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Our meta-analysis was registered with PROSPERO (ID CRD42024621490).
RESULTS: Sixteen trials with a total of 1,968 patients were included in our meta-analysis. OFA was statistically significance associatedwith an improved Quality of Recovery (QoR)-40 score (mean difference 6.33; 95% CI, 3.48-9.17; very low certainty) and QoR-15 score at postoperative 24 hours (mean difference 10; 95% CI, 2.25-17.74; low certainty) compared to OBA. OFA was a statistical significance associated with a reduced risk of postoperative nausea and vomiting, as well as a shorter stay in the postanesthesia care unit. OFA did not reduce postoperative pain and extubation time.
LIMITATIONS: Our meta-analysis has high heterogeneity, with a predominance of women and middle-aged populations in the included studies. Additionally, side effects related to OFA were not analyzed.
CONCLUSIONS: Our systematic review and meta-analysis concluded that it is uncertain whether OFA is superior to OBA in improving postoperative recovery quality. However, OFA leads to a statistically significant reduction in the incidence of postoperative nausea and vomiting. The evidence was primarily drawn from small trials involving elective surgeries. While our results support using OFA, larger and high-quality studies are needed to validate its effect on postoperative recovery quality.
PMID:42263301
