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Opioid-free Anesthesia for Enhancing Recovery Quality at Postoperative 24 Hours: A Systematic Review and
Fei Wang1,2,3, Yihao Zhu4,3, Megchan Ou1,2
1Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, PR China.
Pain Physician
|June 9, 2026
Summary
Opioid-free anesthesia (OFA) may improve recovery quality and reduce nausea after surgery compared to opioid-based anesthesia (OBA). However, evidence is limited, and OFA did not reduce pain or extubation time.
Area of Science:
- Anesthesiology
- Perioperative Medicine
- Evidence-Based Medicine
Background:
- Opioid-free anesthesia (OFA) is increasingly utilized, but its impact on early postoperative recovery remains incompletely understood.
- Traditional opioid-based anesthesia (OBA) carries risks of side effects and dependence.
Purpose of the Study:
- To systematically review and meta-analyze the effects of OFA on postoperative recovery compared to OBA.
- To assess the primary outcome of recovery quality at 24 hours postoperatively.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials comparing OFA and OBA in adult patients.
- Searched multiple databases (MEDLINE, Cochrane, Embase, etc.) up to December 2024.
- Assessed risk of bias using Cochrane RoB 2.0 and evidence certainty with GRADE.
Main Results:
- Sixteen trials (1,968 patients) indicated OFA was associated with improved Quality of Recovery scores (QoR-40 and QoR-15) at 24 hours (very low to low certainty).
- OFA significantly reduced postoperative nausea and vomiting and postanesthesia care unit stay.
- No significant reduction in postoperative pain or extubation time was observed with OFA.
Conclusions:
- The current evidence suggests OFA may offer benefits in reducing postoperative nausea and vomiting, but its superiority in overall recovery quality compared to OBA is uncertain.
- High heterogeneity and limitations in study populations (predominantly women, middle-aged) and lack of side effect analysis were noted.
- Larger, high-quality trials focusing on diverse surgical populations are needed to confirm the benefits of OFA on postoperative recovery quality.
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