Multimodal opioid-free anesthesia containing esketamine versus opioid-based anesthesia: a systematic review and meta-analysis.
Opioid-free esketamine anesthesia lowers risk of intraoperative hypotension versus opioid-based anesthesia.
Multimodal opioid-free anesthesia containing esketamine versus opioid-based anesthesia: a systematic review and meta-analysis.
The paradigm shift toward opioid-free anesthesia (opioid-free anesthesia) is gaining traction, yet evidence regarding specific viable alternatives remains fragmented.
This study conducted a systematic review and meta-analysis by searching the electronic databases PubMed, The Cochrane Library, Web of Science, and Embase, including randomized controlled trials published from inception to September 20, 2024.
opioid-free esketamine anesthesia sharply cut intraoperative low blood pressure
However, multimodal opioid-free anesthesia regimens containing esketamine demonstrated a reduced risk of chronic postoperative pain based exclusively on data from only two thoracic surgery trials (RR = 0.64; 95% CI: 0.44, 0.92; low certainty).
No statistically significant differences were detected in extubation time, PACU length of stay, rescue analgesia requirements, or the incidence of nightmares or hallucinations.
Multimodal opioid-free anesthesia regimens containing esketamine provide comparable postoperative analgesia to opioid-based anesthesia while reducing postoperative nausea and vomiting and intraoperative hypotension.
However, these findings represent combined multimodal effects across heterogeneous settings, and potential benefits for chronic pain prevention should be viewed strictly as hypothesis-generating.