Opioid-free Anesthesia: Time to Regain Our Balance

Fashions come and fashions go. Changes in clothing, automobiles, and restaurants follow popular trends and are often periodic and cyclical. Ideally, medical change is driven not by fashion but instead by concepts of effectiveness and safety, and these concepts should improve and refine as better data become available. Trends hold true also in anesthesia practice, where for example intraoperative opioid selection has swung from long-duration to ultra-short duration and then at least partially back again.¹  Recent years have witnessed a new fashion in anesthesiology: “opioid-free anesthesia.” For some, the opioid pendulum has swung clear past rational opioid use in balanced anesthesia to eliminating opioids intraoperatively and sometimes also postoperatively (opioid-free analgesia). Eradicating opioids from intraoperative and postoperative analgesic plans has been termed a “movement,”²  and like many “movements,” it has attracted passionate proponents and spirited...