Impact of the absence of opioid anesthesia on postoperative outcome indicators: a systematic review and meta-analysis
Abstract
Objective: This study aimed to examine the effect of opioid-free anesthesia (OFA) on postoperative outcome indicators and explore its application in thoracoscopic or laparoscopic as well as non-thoracoscopic or laparoscopic surgeries, providing a scientific basis for clinical decision-making.
Method: A systematic search was conducted for clinical studies comparing OFA and opioid-based anesthesia (OBA) published from the establishment of the databases to May 2025 using databases such as PubMed, Web of Science, Embase, and Cochrane Library. The primary outcome was the incidence of postoperative nausea and vomiting (PONV). Secondary outcomes included perioperative recovery indicators, the need for postoperative emergency analgesia, postoperative pain score (VAS, NRS), and adverse reactions.
Results: A total of 3,766 relevant studies were initially identified, and 68 randomized controlled trials involving 5,426 patients were ultimately included. Compared with OBA, OFA significantly reduced the risks of PONV (RR = 0.50, 95% CI: 0.39-0.64), nausea alone (RR = 0.34, 95% CI: 0.25-0.46), vomiting alone (RR = 0.34, 95% CI: 0.25-0.46), and the need for postoperative emergency analgesia (RR = 0.61, 95% CI: 0.51-0.72). OFA was also associated with lower 24 h postoperative NRS pain scores (SMD = -0.32, 95% CI: -0.53 to -0.10). For outcomes with high heterogeneity (I 2 > 75%), the systematic review showed that most studies did not find a significant reduction in postoperative VAS pain…
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: 5,426 participants or records.
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