Opioid-free anaesthesia as a valuable alternative to opioid-based practices: evidence and future challenges

Opioid-Free-Anesthesia (OFA) offers a valuable alternative model that challenges traditional opioid-based anesthesia practices. Recent studies have tempered expectations regarding the capacity of OFA techniques to improve quality of postoperative pain management and early recovery, in contrast with the clearly decreased risk of postoperative nausea and vomiting. Essentially based on regional anesthesia, non-opioid adjuvants and multimodal analgesia, OFA should be better viewed as a menu rather than a recipe, guided by surgical invasiveness, patient background, expected postoperative pain, and the practitioner's expertise. Potential concerns of OFA, including bradycardia and hypotension, are manageable with proper training and adapted dosing. Further multicentre trials and non-inferiority studies are needed to better define OFA's impact on patient-reported outcome and experiences measures in perioperative care.