Efficacy of opioid-free versus opioid-inclusive anesthesia on postoperative nausea, vomiting, and quality of recovery in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis.
Opioid-free anesthesia lowers postoperative nausea and vomiting risk after thoracoscopic lung surgery
Efficacy of opioid-free versus opioid-inclusive anesthesia on postoperative nausea, vomiting, and quality of recovery in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis.
Postoperative nausea and vomiting (postoperative nausea and vomiting) is common after video-assisted thoracoscopic surgery (video-assisted thoracoscopic surgery).
This review evaluated the effects of opioid-free anesthesia versus opioid-inclusive anesthesia (opioid-inclusive anesthesia) on postoperative nausea and vomiting, pain, and recovery after video-assisted thoracoscopic surgery lung resection.
Randomized controlled trials (randomized controlled trials) involving adults who underwent video-assisted thoracoscopic surgery lung resection and compared opioid-free anesthesia, defined as no intraoperative opioid use, with opioid-inclusive anesthesia, were included.
opioid-free anesthesia cut post-op nausea and vomiting risk versus opioid-inclusive anesthesia
Across the included studies, the mean age of participants ranged from 44.6 to 67.8 years.
Pain scores at 24 h were lower with opioid-free anesthesia (eleven studies; mean difference, - 0.30; 95% CI, - 0.54 to - 0.07), although the difference did not reach the minimally important difference.
Opioid-free anesthesia improved the quality of recovery (quality of recovery) at 24 h (three studies; standardized mean difference, 0.40; 95% CI, 0.07 to 0.72; moderate certainty).
No meaningful difference was observed in postoperative opioid consumption, and adverse event findings were inconsistent.
In selected patients undergoing video-assisted thoracoscopic surgery lung resection within multimodal pathways including regional analgesia, opioid-free anesthesia protocols probably reduce postoperative nausea and vomiting and improve early quality of recovery compared with heterogeneous opioid-inclusive anesthesia regimens, while having little or no clinically important effect on acute postoperative pain.
However, the independent contribution of intraoperative opioid avoidance remains uncertain owing to heterogeneity in regional analgesia, comparator opioid exposure, antiemetic strategies, and anesthetic management.