OPIOID-FREE ANESTHESIA: CURRENT CONCEPTS, CLINICAL EVIDENCE, AND FUTURE DIRECTIONS

Abstract

The practice of anesthesia is gradually changing as clinicians seek methods to reduce opioid-related adverse effects and improve postoperative recovery. In this context, opioid-free anesthesia (OFA) has gained attention as a multimodal approach that avoids the use of intraoperative opioids and instead relies on non-opioid analgesics, regional anesthesia techniques, and various adjuncts to maintain adequate analgesia and hemodynamic stability. This narrative review aims to summarize current evidence on the pharmacological basis, clinical applications, and perioperative outcomes associated with OFA. It evaluates the effectiveness of OFA in reducing opioid-related complications, examines its safety and feasibility across different surgical populations, and discusses its integration within enhanced recovery after surgery (ERAS) protocols. Several studies report a reduction in postoperative nausea and vomiting, ileus, opioid-induced hyperalgesia, respiratory depression, and prolonged postoperative opioid use with OFA. However, variations in study design, patient selection, and anesthetic protocols have led to inconsistent conclusions regarding its advantages over opioid-sparing techniques. This review critically discusses the benefits, limitations, and ongoing controversies surrounding OFA, with particular focus on patient-centered outcomes and practical considerations in routine clinical practice. The potential role of OFA in addressing the broader opioid crisis is also considered. Finally, the need for standardized protocols, long-term outcome data, and individualized analgesic strategies is highlighted to guide future research and clinical application.