Opioid‐free vs. opioid‐inclusive anaesthesia with or without regional anaesthesia for postoperative pain: a systematic review with network meta‐analysis of randomised controlled trials

Regional anaesthesia was the key determinant of improved postoperative pain control, and intra-operative opioids added little additional benefit when regional techniques provided adequate coverage. Without regional anaesthesia, neither opioid-free nor opioid-inclusive strategies showed consistent analgesic superiority. However, opioid-free techniques reduced postoperative nausea and vomiting. These findings support preferential use of regional anaesthesia where feasible and suggest that avoiding intra-operative opioids may facilitate recovery, particularly when regional techniques are employed effectively.