North American and European practices for opioid-sparing and opioid-free anaesthesia: a cross-sectional survey

Background: Opioids remain central to perioperative analgesia but concerns about the growing opioid crisis and adverse effects have prompted revaluation of their role. Opioid-sparing anaesthesia and opioid-free anaesthesia (OFA) have emerged as alternatives, yet their clinical adoption remains uncertain. This survey assessed adoption and perceptions among anaesthesiologists in North America and Europe. Methods: A 26-question cross-sectional, web-based survey was distributed via email to members of the American, European, and French Societies of anaesthesiologists. The survey assessed routine use of opioid-sparing techniques, defined as the regular use of non-opioid analgesics and adjuncts to minimise intraoperative opioid use in the past month. We hypothesised that fewer than 50% of anaesthesiologists routinely used these techniques during this period. Results: <0.001). Key barriers to OFA adoption included limited training, low confidence, and lack of evidence-based guidelines. Conclusions: Interest in opioid-sparing anaesthesia and OFA is widespread, but routine use remains modest and varies by region. Regional perceptions, institutional protocols, and confidence in evidence appear to influence implementation.