I read with great interest the editorial from Kharasch and Clark, titled “Opioid-free Anesthesia: Time to Regain Our Balance.”1  However, after reading the editorial, I am still unclear on why we need such a discussion in the context of Beloeil et al.’s study.2  Opioid-free anesthesia is not just about replacing an opioid with a nonopioid analgesic. Maybe in the United States the use of opioids is more concerning because it is established that 80% of the world opioid consumption occurs in the United States. In my opinion, the real question is: Do we need opioids to optimize perioperative care and recovery of a surgical patient? Although Shanthanna et al.3  provide evidence that opioids are not always required if patients are properly selected and regional anesthesia and complementary techniques are included, consideration should also be given to the role that anesthesiologists may have in perioperative medicine, which, in the case of perioperative pain and opioid requirement, includes their role in the patient preparation for surgery.4  For example, increasing evidence demonstrates that preoperative anxiety, depression, and/or catastrophizing are factors that may increase up to 50% postoperative pain and opioid requirements.5  What makes mood disorders so interesting to consider is that, if identified preoperatively, their effects on postoperative pain and opioid requirements can be “normalized.” Also, as a specialty, we seem to minimize the role of complementary and alternative techniques that, when applied preoperatively, have been shown to reduce perioperative pain and opioid requirements. Examples include acupuncture, music therapy, auriculotherapy,6  aromatherapy, and hypnosis.7 

Opioid-free anesthesia is not about replacing opioids with other analgesics. In many ways, it illustrates what we can achieve as a specialty if we apply a more comprehensive approach to perioperative pain management and opioid requirement.

The author declares no competing interests.

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