Volume 30, Issue 175, September 2026

Opioid-Free Anesthesia in Adult Surgery: A Narrative Review of Current Evidence and Clinical Implications

Joanna Małgorzata Chrabąszcz¹, Adrian Golec¹, Wojciech Piotr Grzywna¹, Angelika Klaudia Juszczyk^2♦, Kinga Kaczmarska¹, Izabela Sylwia Kluczyńska-Kobiec³, Magdalena Małgorzata Lelek⁴, Sylwia Julia Pietrajtis², Kinga Zofia Rosołowska⁵, Agnieszka Suchenia¹

¹Provincial Integrated Hospital in Kielce, Kielce, Poland
²St. Aleksander Hospital in Kielce, Kielce, Poland
³Healthcare Center in Końskie, Końskie, Poland
⁴Faculty of Medicine, Medical University of Łódź, Łódź, Poland
⁵St. Raphael's Voivodeship Specialist Hospital in Czerwona Góra, Chęciny, Poland

^♦Corresponding author
Angelika Klaudia Juszczyk, St. Aleksander Hospital in Kielce, ul. Generała Tadeusza Kościuszki 25, 25-316 Kielce, Poland

ABSTRACT

Opioid-free anesthesia (OFA) is a type of general anesthesia that avoids using opioid medications during surgery. Instead, it relies on a combination of non-opioid drugs like dexmedetomidine, ketamine, intravenous lidocaine, clonidine, and regional anesthesia techniques. The main aim of OFA is to lower the risk of opioidrelated side effects, such as postoperative nausea and vomiting (PONV), breathing problems, constipation, drowsiness, and opioid-induced hyperalgesia. Aim: This narrative review presents a summary of what is known regarding the use of OFA in adult patients. Methods: The authors carried out a literature search using PubMed, the Cochrane Library, Scopus, and Google Scholar. They analyzed the studies that were published between 2020 and 2026. Randomized controlled trials, systematic reviews, and meta-analyses that assessed the efficacy and safety of opioid-free anesthesia were included. Results: Evidence indicates that opioid-free anesthesia significantly reduces postoperative nausea and vomiting and may improve postoperative quality of recovery in surgical populations. However, no consistent superiority has been demonstrated regarding postoperative pain intensity or postoperative opioid consumption compared with opioid-sparing or conventional opioid-based anesthesia. OFA protocols based on α2-agonists may increase the risk of bradycardia and prolonged recovery time. Conclusion: Its clearest benefit appears to be in patients in whom opioid-related adverse effects, especially postoperative nausea and vomiting, are a particular concern. At present, the evidence is insufficient to justify replacing opioid-sparing anesthesia with OFA as a routine strategy. In practice, the decision to avoid intraoperative opioids should therefore depend on the individual patient, the type of surgery, and the expected benefits and risks of the drugs included in the anesthetic protocol.

Keywords: opioid-free anesthesia, opioid-sparing anesthesia, multimodal anesthesia, perioperative care

Medical Science, 2026, 30, e197ms3989

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DOI: https://doi.org/10.54905/disssi.v30i175.e197ms3989

Published: 29 September 2026