Impact of opioid free anesthesia on postoperative nausea and vomiting, chronic pain, and quality of recovery in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials.
Opioid-free anesthesia lowers postoperative nausea and vomiting risk after thoracoscopic surgery
Impact of opioid free anesthesia on postoperative nausea and vomiting, chronic pain, and quality of recovery in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials.
Opioids are frequently used in general anesthesia but may delay recovery owing to adverse effects, which include respiratory depression, postoperative nausea and vomiting (postoperative nausea and vomiting), and opioid-induced hyperalgesia.
PubMed, Web of Science, Embase, and Cochrane Library were systematically searched from inception to March 01, 2025, for randomized controlled trials (randomized controlled trials) that compared opioid-free anesthesia and opioid-based anesthesia (opioid-based anesthesia) in patients undergoing video-assisted thoracoscopic surgery (video-assisted thoracoscopic surgery).
opioid-free anesthesia cut postoperative nausea and vomiting risk by more than half
This systematic review and meta-analysis consisted of 10 randomized controlled trials involving 1,106 patients.
However, the 24-h postoperative pain scores did not differ (MD = 0.082, p = 0.305).
Bradycardia incidence was lower in the opioid-free anesthesia group, but hypotension rates did not differ.
Although 24-h QoR-40 scores favored opioid-free anesthesia (mean difference = 2.914, 95% CI: 1.017-4.811), this improvement did not reach the clinically established threshold of 6.3 points.
Without worsening intraoperative hemodynamic instability or extending postoperative recovery, opioid-free anesthesia significantly reduced the incidence of postoperative nausea and vomiting and chronic pain in patients undergoing video-assisted thoracoscopic surgery.
These results validate opioid-free anesthesia as a potentially safe and effective anesthetic strategy for improving postoperative recovery after thoracic surgery.
Further large-scale randomized controlled trials are warranted to standardize opioid-free anesthesia protocols and validate its long-term advantages.