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. 2025 Aug 18:12:1639968.
doi: 10.3389/fmed.2025.1639968. eCollection 2025.

Impact of the absence of opioid anesthesia on postoperative outcome indicators: a systematic review and meta-analysis

Jiarun Qin  1 , Jialei Zhang  2 , Jianing Bo  1 , Xiaoyan Ma  1 , Xiaofeng He  3
Affiliations

Impact of the absence of opioid anesthesia on postoperative outcome indicators: a systematic review and meta-analysis

Jiarun Qin et al. Front Med (Lausanne). .

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 scores with OFA. However, over two-thirds of the studies have shown that OFA can improve the quality of postoperative recovery (QoR-40). Approximately half of the studies suggested that OFA may prolong extubation time, while most found no significant difference in PACU stay time.

Conclusion: In summary, OFA not only significantly reduces postoperative PONV, but also lowers the demand for analgesic drugs and improves the quality of postoperative recovery. However, its effect on some postoperative recovery indicators is limited, and further high-quality studies are required to confirm these findings. OFA is expected to serve as a safe and effective anesthesia strategy to optimize the perioperative outcomes of patients.

Keywords: meta-analysis; opioid drugs; opioid-free anesthesia; postoperative recovery; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of literature screening.
Figure 2
Figure 2
(A) The proportion of each methodological quality item. (B) The methodological quality assessment.
Figure 3
Figure 3
(A) The forest plot of the impact of OFA on PONV. (B) The sensitivity analysis plot of the impact of OFA on PONV. (C) The forest plot of the impact of OFA on PONV after excluding low-quality studies. (D) Trim and fill method for PONV.
Figure 4
Figure 4
(A) The forest plot of the impact of OFA on nausea. (B) The sensitivity analysis plot of the impact of OFA on nausea. (C) The forest plot of the impact of OFA on nausea after excluding low-quality studies. (D) The funnel plot of the impact of OFA on nausea.
Figure 5
Figure 5
(A) The forest plot of the impact of OFA on vomiting. (B) The sensitivity analysis plot of the impact of OFA on vomiting. (C) The forest plot of the impact of OFA on vomiting after excluding low-quality studies. (D) Trim and fill method for vomiting.
Figure 6
Figure 6
(A) The forest plot of the impact of OFA on postoperative emergency analgesia needs. (B) The sensitivity analysis plot of the impact of OFA on postoperative emergency analgesia needs. (C) The forest plot of the impact of OFA on postoperative emergency analgesia needs after excluding low-quality studies. (D) Trim and fill method for postoperative emergency analgesia needs.
Figure 7
Figure 7
The forest plot of the impact of OFA on LOS.
Figure 8
Figure 8
(A) The forest plot of the impact of OFA on postoperative respiratory dysfunction. (B) The forest plot of the impact of OFA on postoperative intestinal dysfunction. (C) The forest plot of the impact of OFA on bradycardia. (D) The forest plot of the impact of OFA on bradycardia after excluding low-quality studies.
Figure 9
Figure 9
The forest plot of the impact of OFA on NRS.
Figure 10
Figure 10
(A) The forest plot of the impact of OFA on VAS. (B) The forest plot of the impact of OFA on QOR-40. (C) The forest plot of the impact of OFA on postoperative extubation time. (D) The forest plot of the impact of OFA on postoperative PACU stay time.
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