A&A Pro-Con Debate: Opioid-Free Versus Opioid-Conventional for Patients Undergoing General Anesthesia

In this Pro-Con commentary article, the Pro perspective advocates for the integration of opioid-free anesthesia (OFA) techniques in perioperative care, highlighting their benefits, including significant reductions in postoperative nausea and vomiting (PONV). Meta-analyses have shown that OFA protocols effectively reduce PONV rates despite variability in protocols and surgical populations. Furthermore, OFA techniques provide effective pain control, often demonstrating analgesic outcomes comparable to conventional opioid-based techniques. Conversely, the Con perspective raises concerns about the increased risk of adverse events associated with OFA protocols, such as bradycardia, hypotension, and prolonged recovery times, as evidenced by large randomized controlled trials. Critics emphasize the lack of standardization in OFA protocols, variability in definitions, and limited timeframe for outcome assessment, which complicates comparisons and generalizability. Additionally, they point out that while OFA reduces intraoperative opioid use, it does not necessarily translate into decreased opioid prescribing at discharge, a key factor in addressing persistent opioid use.