Effect of opioid-free anesthesia on the incidence of postoperative nausea and vomiting: A meta-analysis of randomized controlled studies

Abstract

Background: Research on opioid-free anesthesia has increased in recent years; however, it has never been determined whether it is more beneficial than opioid anesthesia. This meta-analysis was primarily used to assess the effect of opioid-free anesthesia compared with opioid anesthesia on the incidence of postoperative nausea and vomiting. Methods: We searched the electronic databases of PubMed, the Cochrane Library, Web of Science and Embase from 2014 to 2022 to identify relevant articles and extract relevant data. The incidence of postoperative nausea and vomiting, time to extubation, pain score at 24 hours postoperatively, and time to first postoperative rescue analgesia were compared between patients receiving opioid-free anesthesia and those receiving standard opioid anesthesia. Differences in the incidence of postoperative nausea and vomiting were evaluated using risk ratios (95% confidence interval [CI]). The significance of the differences was assessed using mean differences and 95% CI. The heterogeneity of the subject trials was evaluated using the I 2 test. Statistical analysis was performed using the RevMan 5.4 software. Results: Fourteen randomized controlled trials, including 1354 participants, were evaluated in the meta-analysis. As seen in the forest plot, the OFA group had a lower risk of postoperative nausea and vomiting than the control group (risk ratios = 0.41, 95% CI: 0.33–0.51, P < .00001; n = 1354), and the meta-analysis also found that the OFA group had lower postoperative analgesia scores at 24 hours (P < .000001), but time to extubation (P = .14) and first postoperative resuscitation analgesia time (P < .54) were not significantly different. Conclusions: Opioid-free anesthesia reduces the incidence of postoperative nausea and vomiting while providing adequate analgesia without interfering with postoperative awakening.

Effect of opioid-free anesthesia on postoperative nausea and vomiting after gynecological surgery: a systematic review and meta-analysis

“…Previous studies have found that opioid-free anesthesia can reduce postoperative nausea and vomiting in patients (Frauenknecht et al, 2019;Salomé et al, 2021;Feenstra et al, 2023;Malo-Manso et al, 2023;Zhang et al, 2023) and improve the quality of postoperative recovery (Feenstra et al, 2023), which is consistent with the results of this meta-analysis of opioid-free gynecological surgery. But two meta-analyses found that opioid-free anesthesia reduced postoperative pain in patients (Malo-Manso et al, 2023;Zhang et al, 2023) and one showed that opioid-free anesthesia reduced extubation time (Zhang et al, 2023), which is different from our results.…”

Opioid-free general anesthesia: considerations, techniques, and limitations

“…Similar observations were made in a recent randomized trial on women having gynecological surgeries with OFA achieved using esketamine and dexmedetomidine [26]. A recent meta-analysis claiming data from 14 RCTs compared opioid-free vs. opioid-based anesthesia and noted a lower PONV [relative risk 0.41, 95% confidence interval (95% CI): 0.33-0.51] [15]. On a closer look, we see that the largest contribution came from a retrospective cohort study [27], and the number of PONV patients inflated by 10 in the opioid group [15].…”

“…Appreciating that there are procedurespecific differences in postoperative outcomes, it may be best to consider agents based on surgical procedure. Even this is problematic, as the choice is arbitrary with no attempts to be consistent [15]. Laparoscopic cholecystectomy is a good example.…”

“…A recent meta-analysis claiming data from 14 RCTs compared opioid-free vs. opioid-based anesthesia and noted a lower PONV [relative risk 0.41, 95% confidence interval (95% CI): 0.33-0.51] [15]. On a closer look, we see that the largest contribution came from a retrospective cohort study [27], and the number of PONV patients inflated by 10 in the opioid group [15]. In another meta-analysis of RCTs in gynecologic surgery [28], the largest effect was seen in a study by Hakim et al [29] on laparoscopic surgeries of less than 60 min, comparing only dexmedetomidine and fentanyl with no other analgesic components.…”