The progress in the clinical application of opioid-free anesthesia: a narrative review

Abstract

Background and Objective: Opioid-free anesthesia (OFA) is a new concept of anesthesia, but its evaluation is still controversial in the domestic and international anesthesiology community. This review summarizes the latest research progress, the advantages, the disadvantages of OFA, clinical applications as well as current challenges and perspectives. Studies have shown that opioid abuse and misuse produce a series of serious problems, and weighing their advantages and disadvantages, the rational use of opioid analgesics in anesthesia and pain management has attracted the attention of scholars at home and abroad. Although opioid use in our surgical patients is currently low, there is a clear upward trend, so anesthesiologists should actively confront the issue of opioid side effects and its abuse and addiction. Over the past 30 years, postoperative pain management efforts have been driven by the idea of reducing/eliminating postoperative opioids. However, in line with modern concepts of anesthesia, we should actively explore ways to eliminate opioids in the perioperative period in order to achieve a balanced, opioid-free approach to anesthesia (i.e., OFA). Methods: PubMed, Cochrane, and Scopus databases were searched with related keywords. All publication types in English that were related to adult humans between December 1993 and December 2021 were included. Key Content and Findings: Cancer surgery and head, neck, and maxillofacial surgery may be potential indications for OFA. Conclusions: OFA, as part of a multimodal approach to anesthesia, has been shown to be effective in specific types of surgery. We should be fully researched and developed.