Opioid-Free Anesthesia and Multimodal Analagesia in Cardiac Surgery: A Narrative Review

Opioid-free anesthesia (OFA) has emerged as a promising alternative in cardiac surgery, aiming to reduce opioid-related adverse effects while maintaining effective perioperative analgesia. This narrative review examines current clinical evidence supporting OFA strategies, particularly the use of multimodal analgesia (MMA) incorporating agents such as dexmedetomidine, ketamine, lidocaine, magnesium, gabapentinoids, and Non-Steroidal Anti-inflammatory Drugs (NSAIDs). These regimens target multiple pain pathways to minimize reliance on opioids. Studies indicate that OFA can significantly reduce postoperative opioid consumption, improve pain control, decrease the incidence of nausea and vomiting, and enhance functional recovery outcomes. Despite these benefits, concerns remain regarding intraoperative hemodynamic stability, particularly the risks of bradycardia, hypotension, and delayed emergence. Current evidence supports the safety and efficacy of OFA and MMA in cardiac surgical settings, although large-scale, high-quality trials are still needed to standardize protocols and assess long-term outcomes. As the adoption of OFA and MMA expands, their integration into Enhanced Recovery After Surgery (ERAS) protocols may improve perioperative care and reduce opioid dependence in cardiac surgery patients.