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

George, Collin

doi:10.5281/zenodo.17537970

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

George, Collin

Publisher: Zenodo
DOI: 10.5281/zenodo.17537970
Repository: zenodo.org
Language: en

Abstract

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

Full text

Table 1. SANRA Self-Assessment for Narrative Review Quality SANRA Item Description and Implementation Score (0–2) Importance justification Opioid crisis context (81,083 deaths, CDC 2023) establishes clinical need for safer perioperative analgesia 2 Aims statement Clear objectives stated: evaluate NOA efficacy/safety, assess ERAS integration, identify implementation barriers 2 Literature description Comprehensive PubMed/Scopus/Cochrane search, transparent selection (1,200 records →45–50 studies) 2 Referencing Predominantly recent peer-reviewed sources (¿80% from 2020–2024), foundational works from 2010–2015 2 Scientific reasoning Mechanisms explained (e.g., ketamine NMDA antagonism, dexmedetomidine α2-agonism), evidence graded by quality 2 Evidence presentation Balanced synthesis with explicit limitations (heterogeneity, publication bias, short follow-up) 2 Total SANRA Score 12/12