Opioid-Free and Opioid-Sparing Pain Control in Surgical Anesthesia: A Scoping Review of Multimodal Analgesia, Regional Techniques, and Recovery Outcomes

Surgical anesthesia has historically relied on opioids to control intraoperative and postoperative pain, but opioid-related adverse effects such as respiratory depression, sedation, ileus, postoperative nausea and vomiting, delayed mobilization, tolerance, hyperalgesia, and prolonged opioid use have encouraged a shift toward safer perioperative analgesic models. In this scoping review, opioid-free anesthesia (OFA) is defined as the complete avoidance of opioid administration during the intraoperative period, whereas opioid-sparing anesthesia (OSA) is defined as an anesthetic approach that intentionally reduces, but does not eliminate, intraoperative opioid use through non-opioid pharmacologic agents, regional anesthesia, local anesthetic techniques, or multimodal analgesic strategies. Despite growing interest in opioid-free and opioid-sparing anesthesia, available evidence remains inconsistent because studies differ in drug combinations, dosing schedules, surgical populations, regional techniques, rescue analgesia protocols, and recovery measurements. This scoping review evaluates contemporary opioid-free pain control in surgical anesthesia, focusing on multimodal pharmacology, regional anesthesia, fascial plane blocks, enhanced recovery pathways, patient-centered outcomes, safety, and risk stratification. Literature published between January 2018 and May 2026 was searched in PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Forty-six articles were included and narratively mapped across pharmacologic strategies, regional techniques, enhanced recovery after surgery (ERAS) pathways, recovery outcomes, safety considerations, and risk-stratification themes. Current evidence suggests that opioid-free and opioid-sparing strategies may reduce perioperative opioid exposure and selected opioid-related adverse effects in appropriately selected procedures and patients, although findings remain heterogeneous. The strongest benefit appears when non-opioid drugs, regional techniques, and ERAS principles are combined within procedure-specific pathways. Opioid-free anesthesia should be considered a flexible, individualized strategy rather than a universal replacement for balanced anesthesia.