Opioid‐free vs. opioid‐inclusive anaesthesia with or without regional anaesthesia for postoperative pain: a systematic review with network meta‐analysis of randomised controlled trials

Journal article : Review

Plain Language Summary: What we did: We looked at many studies from around the world that compared different ways of giving anaesthesia (the medicine that keeps you asleep during surgery). We compared six types of anaesthesia, including some that used opioids (strong pain medicines) and some that did not. We also looked at whether a special kind of numbing, called regional anaesthesia, was used. We checked how well each method worked for pain after surgery and other outcomes like sickness and time in hospital. Why did we do it: Doctors are worried about the side effects of opioids, so they want to know if people can stay comfortable after surgery without using them. We wanted to find out which combinations of anaesthesia give the best pain control and the fewest problems after surgery. What we found: The best pain control happened when regional anaesthesia was used, no matter what other medicines were given. When regional anaesthesia was already helping, using or avoiding opioids during the operation didn't make much difference to pain afterwards. People who did not get regional anaesthesia had more pain and needed more opioids later. Opioid‐free techniques (especially when combined with regional anaesthesia) led to less sickness and vomiting after surgery. Overall, the results show that regional anaesthesia is the most important part for good pain control. Avoiding opioids during the operation may also help people feel better afterwards, especially when regional anaesthesia is used.

Authors: de Carvalho, CC; El‐Boghdadly, K; Guedes, IHL; Dantas, MVM; Tomé, DPB

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Wiley
• Journal: Anaesthesia: Peri-operative medicine, critical care and pain
• Publication date: 2026-01-05
• Acceptance date: 2025-11-23
• DOI: 10.1111/anae.70121
• EISSN: 1365-2044
• ISSN: 0003-2409
• Language: English
• Keywords: opioid‐free anaesthesia; regional anaesthesia; postoperative pain; systematic review; analgesia
• Subtype: Review