MINI REVIEW article
Front. Anesthesiol.
Sec. Perioperative Medicine
Volume 4 - 2025 | doi: 10.3389/fanes.2025.1714040
This article is part of the Research TopicPerioperative Optimization and Perioperative Medicine: Optimizing Outcomes and Safety across Surgical CareView all articles
OPIOID-FREE ANESTHESIA (OFA): A SCOPING REVIEW OF EFFICACY, SAFETY, AND IMPLEMENTATION CHALLENGES
Provisionally accepted
- 1Kansas City University, Kansas City, United States
- 2Cedars-Sinai Medical Center, Los Angeles, United States
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Background: Opioid-free anesthesia (OFA) is a multimodal strategy to avoid intraoperative opioids and minimize associated complications, though evidence remains variable. Methods: A systematic search of PubMed and Google Scholar (2010-2025), supplemented by AI tools (Google Gemini) for earlier publications, summarized eligible studies (RCTs, cohorts, systematic reviews, and meta-analyses) comparing OFA to opioid-based anesthesia (OBA). Data were summarized following PRISMA-ScR guidelines. Results: Across 23 randomized controlled trials and one cohort study, OFA consistently reduced PONV, while demonstrating analgesia and recovery outcomes comparable to OBA. Hemodynamic stability was variable, with dexmedetomidine-based OFA regimens sometimes associated with increased bradycardia and hypotension. PACU stay varied, ranging from 9 minutes shorter to 15-35 minutes longer with OFA. Long-term outcome data are limited. Conclusion: OFA is a feasible approach that significantly reduces PONV while maintaining comparable analgesia and recovery. However, heterogeneous protocols, small sample sizes, and scarce long-term data limit external validity. Large, multicenter trials are needed to standardize OFA protocols and clarify long-term outcomes.
Keywords: Opioid-Free Anesthesia (OFA), Multimodal analgesia, Enhanced recovery after surgery (ERAS), Postoperative pain, non-opioid analgesics, Opioid crisis
Received: 26 Sep 2025; Accepted: 16 Oct 2025.
Copyright: © 2025 Pershad, Elvir Lazo and Wong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ofelia Loani Elvir Lazo, loani.elvir-lazo@cshs.org
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