Non-Opioid Anesthesia for Perioperative Pain Management: Evidence, Implementation, and Future Directions — A Narrative Review

Non-opioid anesthesia (NOA) in perioperative pain management: a narrative review of efficacy, implementation, and future directions

Abstract
The opioid crisis has driven adoption of non-opioid anesthesia (NOA) and opioid-free anesthesia (OFA) in surgical care. This narrative review synthesizes evidence (2006–2024) on multimodal analgesia, regional anesthesia, and adjunct agents (ketamine, dexmedetomidine, lidocaine) in orthopedic, abdominal, and thoracic surgery. NOA reduces opioid consumption by 50–80% while maintaining analgesia, with strongest evidence in Enhanced Recovery After Surgery (ERAS) protocols. Benefits include shorter length of stay (1–2 days), reduced postoperative nausea/vomiting (PONV), and lower ileus risk. Trade-offs include bradycardia (5–15%) and hypotension (10–20%). Implementation barriers (training, cost, protocol heterogeneity) and future priorities (long-term outcomes, AI-guided titration) are discussed.

Keywords: non-opioid anesthesia; opioid-free anesthesia; multimodal analgesia; perioperative pain; Enhanced Recovery After Surgery; ERAS; ketamine; dexmedetomidine; regional anesthesia; opioid crisis; anesthesiology; narrative review

MeSH terms: Analgesia; Anesthesia; Pain Management; Opioid-Related Disorders; Enhanced Recovery After Surgery

License: CC BY 4.0 International

DOI Source: Preprint version uploaded prior to peer-reviewed journal submission. This is not the final published version.