Authors: Nasr E, et al.
Cureus 17(10): e95726. DOI: 10.7759/cureus.95726
Summary
This narrative review examines opioid-free and opioid-sparing anesthesia strategies—centered on dexmedetomidine, lidocaine, esketamine, multimodal non-opioid analgesics, and regional blocks—within ERAS frameworks. Across varied surgeries (including ambulatory and pediatric settings), consistent benefits are reduced postoperative nausea and vomiting, quicker return of bowel function, and lower rescue-opioid use, with similar PACU times and often comparable pain scores. However, analgesic superiority over opioid-based techniques is generally modest and sometimes clinically marginal. Safety signals cluster around α2-agonists (notably dexmedetomidine), with increased bradycardia, hypotension, and occasionally prolonged sedation—highlighting the need for judicious dosing, patient selection, and hemodynamic vigilance. The authors advocate a pragmatic “opioid-sparing” default—minimizing rather than eliminating opioids—while future trials refine optimal drug combinations, dosing (especially lower dexmedetomidine), the role of postoperative low-dose infusions, and protocolized integration of targeted regional anesthesia.
What You Should Know
• Reliable wins: less PONV, faster GI recovery, and reduced rescue-opioid use; pain scores usually similar.
• Biggest caution: dexmedetomidine can cause bradycardia/hypotension and deeper sedation—dose carefully and monitor.
• ERAS fit: OFA/opioid-sparing pairs naturally with ERAS; consider as a component, not a doctrine.
• Where it shines: bariatric and select pediatric cases where avoiding opioid-induced respiratory depression is critical.
• Practical takeaway: make multimodal, opioid-sparing the default; reserve strict OFA for experienced teams and well-selected patients while evidence matures.
References
None cited beyond the reviewed article.
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