Impact of opioid free anesthesia on postoperative nausea and vomiting, chronic pain, and quality of recovery in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials
Abstract
Background: Opioids are frequently used in general anesthesia but may delay recovery owing to adverse effects, which include respiratory depression, postoperative nausea and vomiting (PONV), and opioid-induced hyperalgesia. Opioid-free anesthesia (OFA), based on multimodal analgesia, offers an alternative to mitigate these issues and enhance recovery in thoracic surgery. However, high-quality evidence confirming its effectiveness and safety is needed.
Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in this study. PubMed, Web of Science, Embase, and Cochrane Library were systematically searched from inception to March 01, 2025, for randomized controlled trials (RCTs) that compared OFA and opioid-based anesthesia (OBA) in patients undergoing video-assisted thoracoscopic surgery (VATS). Study titles, abstracts, and full texts were separately evaluated for eligibility by two researchers; disagreements were resolved by discussion or a third researcher. The Cochrane Risk of Bias tool was used to evaluate the risk of bias in included studies. Primary outcomes included PONV incidence and 24-h postoperative pain scores. Secondary outcomes included chronic pain, intraoperative hemodynamic events, length of stay in the recovery room, length of hospitalization, and quality of recovery (as measured by QoR-40/QoR-15).
Results: This systematic review and meta-analysis consisted of 10 RCTs involving 1,106 patients. OFA reduced the…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,106 participants or records.
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