Opioid-Free Anesthesia Versus Opioid-Based Anesthesia for Video-Assisted Thoracoscopic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE

To compare and evaluate the effects of opioid-free anesthesia (OFA) versus opioid-based anesthesia (OA) on intraoperative and postoperative outcomes in video-assisted thoracoscopic surgery (VATS).

DESIGN

A meta-analysis of randomized controlled trials.

SETTING

Hospitals.

PARTICIPANTS

A total of 836 patients from 7 randomized controlled studies were included in the analysis.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Seven studies involving 836 patients were included. Compared with OA, OFA showed significantly reduced risk of postoperative nausea and vomiting (PONV) (Mantel-Haenszel risk ratio = 0.52; 95% CI, 0.35-0.78). However, no significant difference was seen between the 2 groups for resting postoperative pain (Hedges' g = -0.08; 95% CI, -0.25 to 0.10), dynamic postoperative pain (Hedges' g = -0.52; 95% CI, -1.26 to 0.22), postoperative opioid requirements (Hedges' g = -0.12; 95% CI, -0.43 to 0.20), length of postanesthesia care unit (mean difference [MD] = 4.02; 95% CI, -3.26 to 11.31), or hospital stay (MD = 0.35; 95% CI, -0.06 to 0.77).

CONCLUSIONS

This meta-analysis compared OA with OFA in VATS and ensured that regional anesthesia techniques were similar in both groups. Compared to OA, OFA reduces the incidence of PONV but showed no significant difference in other clinical outcomes. OFA may become an important part of VATS, especially in patients at high risk of PONV.