Opioid-free anaesthesia. Why and how? A contextual analysis

Area of Science:

• Anesthesiology
• Pain Management
• Pharmacology

Background:

• The historical use of natural and synthetic opioids in anesthesia, particularly fentanyl since 1962, has led to high-dose intraoperative administration.
• Recent research increasingly questions the established practice of using opioids during surgery due to side effects and unknown long-term impacts.

Observation:

• The human body's production of endogenous opioids and the perception of pain during general anesthesia are complex and not fully understood.
• The direct effects of intraoperative opioid administration on the development and severity of postoperative pain remain a significant area of investigation.

Findings:

• Opioid-free anesthesia (OFA) techniques have emerged in response to a growing understanding of perioperative pain mechanisms.
• While OFA is feasible, its clinical efficacy and added value compared to opioid-sparing methods require further formal evaluation.

Implications:

• This work encourages a re-evaluation of intraoperative opioid utilization from historical and evolutionary perspectives.
• Further research is needed to rigorously test the benefits of OFA against current opioid-minimizing anesthesia strategies.