Opioid-free anesthesia

Opioid-free anesthesia (OFA) is emerging as a new stimulating research perspective. The rationale to propose OFA is based on the aim to avoid the negative impact of intraoperative opioid on a patient's postoperative outcomes and also on the physiology of pathways involved in intraoperative nociception. It is based on the concept of multimodal anesthesia. OFA has been shown to be feasible but the literature is still scarce on the clinically meaningful benefits for patients as well as on the side effects and/or complications that might be associated with it. This review focused first on the physiology of nociception, the reasons for using or not using opioids during anesthesia, and then on the literature reporting evidence-based proofs of benefits/risks associated with OFA.