Opioid-free anesthesia yields superior results compared to opioid-based anesthesia in spine surgery: a systematic review and meta-analysis of randomized controlled trials.

Abstract

This systematic review and meta-analysis aimed to conduct a systematic review and meta-analysis to evaluate whether opioid-free anesthesia (OFA) is as effective as opioid-based anesthesia (OBA) in managing perioperative pain in spine surgery patients. Given the well-documented adverse effects of opioids, there has been a growing interest in performing surgeries using OFA. However, the effectiveness of OFA in managing postoperative pain remains uncertain. Prior studies have yielded inconclusive results, and to date, no systematic review of randomized controlled trials (RCTs) has evaluated completely opioid-free analgesia in spine surgery. A systematic review was performed using PubMed, Web of Science, and Embase, with results imported into Covidence. Two reviewers independently screened 1,376 titles and abstracts, reviewed 54 full-text articles, and extracted data from eight eligible RCTs. Extracted outcomes included patient- reported postoperative pain, pain-free period, rescue analgesia use, and postoperative nausea/vomiting (PONV). Statistical analysis was conducted using RevMan Web with results reported as mean differences (MDs) and risk ratios (RR). OFA group reported lower postoperative visual analog scale scores than the OBA group (MD, -18.22), though the difference was not statistically significant. OFA showed a significantly lower risk of rescue analgesia use in the post-anesthesia care unit (RR, 0.34) and a significantly longer postoperative pain-free period (MD, 3.36 hours). At 24 hours, numerical rating scale scores were significantly lower in the OFA group (MD, -0.79). OFA also resulted in significantly reduced total rescue analgesia consumption (MD, -4.15 mg oral morphine) and a significantly lower risk of postoperative nausea and vomiting (RR, 0.56). OFA is effective in certain spine surgeries, offering comparable or improved pain control 24 hours postoperatively, reduced rescue analgesia use, and less PONV. Further studies are needed to obtain more robust findings.