North American and European practices for opioid-sparing and opioid-free anaesthesia: a cross-sectional survey

Opioids remain central to perioperative analgesia but concerns about the growing opioid crisis and adverse effects have prompted revaluation of their role. Opioid-sparing anaesthesia and opioid-free anaesthesia (OFA) have emerged as alternatives, yet their clinical adoption remains uncertain. This survey assessed adoption and perceptions among anaesthesiologists in North America and Europe.

A 26-question cross-sectional, web-based survey was distributed via email to members of the American, European, and French Societies of anaesthesiologists. The survey assessed routine use of opioid-sparing techniques, defined as the regular use of non-opioid analgesics and adjuncts to minimise intraoperative opioid use in the past month. We hypothesised that fewer than 50% of anaesthesiologists routinely used these techniques during this period.

The overall response rate was 2% among ASA members (614/31 000) and 12% among European Society of Anaesthesiology and Intensive Care (ESAIC) members (414/3500). Concern about opioid use was reported as high in ESAIC and ASA members (90% vs 83%, P<0.001). Daily use of opioid sparing techniques was reported by 37% (95% confidence interval [CI] 32-42%) of ESAIC and 40% (95% CI 36-45%) of ASA members. OFA use was less common overall but reported to be higher by ASA repondents (21%, 95% CI 18-25%) vs 12% (95% CI 9-15%), P<0.001) for EASIC respondents. Perceived risks differed: EASIC respondents more often cited haemodynamic instability (43% vs 16%, P<0.001), whereas ASA respondents more often cited patient dissatisfaction (55% vs 30%) and uncontrolled pain (72% vs 53%, both P<0.001). Key barriers to OFA adoption included limited training, low confidence, and lack of evidence-based guidelines.

Interest in opioid-sparing anaesthesia and OFA is widespread, but routine use remains modest and varies by region. Regional perceptions, institutional protocols, and confidence in evidence appear to influence implementation.