Unveiling the Uncertainties: Opioid-free Anesthesia and the Road Ahead

Opioids are widely considered to be effective analgesics in the perioperative period. However, they are also commonly associated with a myriad of adverse effects that can be detrimental toward a patient’s recovery. These prominent adverse effects combined with concerns surrounding the opioid crisis have led anesthesiologists to appropriately question the role and even the need for opioids during the perioperative period and in particular intraoperatively. Under general anesthesia, patients do not experience the required psychologic components of pain and therefore only experience nociception. During surgery, nociception is typically managed using surrogates including hemodynamic variation, respiratory rate changes and patient movement. Given that it is possible to control these markers of nociception through nonopioid medications, the concept of “opioid-free anesthesia” (OFA), in which no opioids are administered intraoperatively, has emerged as a feasible anesthetic technique. However, despite the increasing interest and popularity of OFA over the past two decades, rigorous evidence...