We read with interest three recently published articles in which opioid-free anesthesia was discussed.1–3  However, we would like to address several concerns regarding the scientific discussion of these publications.

Beloeil et al. hypothesize that opioid-free anesthesia balanced with dexmedetomidine reduces postoperative opioid-related adverse events compared with balanced anesthetic with remifentanil. The results of this trial showed a greater incidence of serious adverse events, especially hypoxemia and bradycardia, in the dexmedetomidine group. However, the trial just compared remifentanil with dexmedetomidine, with ketamine and intravenous lidocaine in both groups. The use of locoregional analgesia or nonsteroidal anti-inflammatory drugs was excluded. Furthermore, the protocol mentioned that dexmedetomidine dosage should be in the range of 0.4 to 1.4 µg·kg−1·h−1 and dose adjustments were based on heart rates of the patients and monitored by analgesia nociception index. However,...

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