Safety and effectiveness of multimodal opioid-free anaesthesia for pain and recovery after laparoscopic surgery: a systematic review and meta-analysis.

Summary

Across 12 randomized trials (983 patients), opioid-free anesthesia was associated with lower early postoperative pain (0–2 h; MD −1.29 on a 0–10 scale). The synthesis also evaluated opioid consumption, QoR-40, PONV and recovery metrics, supporting OFA as a viable strategy to enhance early recovery after laparoscopy.

Key Findings

• Included 12 RCTs with 983 patients undergoing laparoscopic surgery.
• OFA reduced early postoperative pain at 0–2 hours versus opioid anesthesia (MD −1.29; 95% CI −2.23 to −0.36).
• Outcomes synthesized included opioid consumption, QoR-40, PONV, extubation time, and PACU discharge time under random-effects modeling.

Clinical Implications

Consider adopting multimodal OFA protocols for laparoscopic procedures to reduce early pain and potentially improve recovery metrics (e.g., PONV, readiness for discharge), while standardizing regimen components and monitoring hemodynamics.

Limitations

• Heterogeneity in OFA drug combinations and dosing across trials.
• Limited to laparoscopic surgery; durability of benefits beyond 24 hours not fully defined.

Future Directions

Define standardized OFA regimens, assess safety signals (e.g., bradycardia/hypotension), and extend evaluation to open procedures and high-risk populations with longer follow-up.