Opioid-Free Anesthesia Versus Opioid-Based Anesthesia in Pediatric Dental Day-Case Surgery: A Retrospective Cohort Study of Safety and Efficacy.

Introduction Opioid-free anesthesia (OFA) is increasingly utilized in pediatric surgeries to minimize opioid-related complications, such as postoperative nausea and vomiting (PONV) and delayed recovery. Its efficacy in pediatric dental day-case surgery remains underexplored. This study compares the safety and efficacy of OFA versus opioid-based anesthesia (OBA) in this setting. Materials and methods A retrospective cohort study reviewed medical records of 175 children (aged 3-10 years, ASA I/II) who underwent dental crowns/restorations between January 2024 and May 2025. Patients were grouped into OBA (n = 100) and OFA (n = 75) cohorts. Outcomes included postoperative pain scores, post-anesthesia care unit (PACU) duration, PONV incidence, rescue analgesic use, and unplanned admissions. Results Pain scores were 0.0 ± 0.0 in both groups at 0-2 hours and two to six hours post-surgery (OBA: 100/100, 100%; OFA: 75/75, 100%). PACU duration was significantly shorter in the OFA group (18.11 ± 6.88 minutes) compared to the OBA group (27.78 ± 11.03 minutes; p < 0.001). No patients experienced PONV (OBA: 0/100, 0%; OFA: 0/75, 0%), required rescue analgesics (OBA: 0/100, 0%; OFA: 0/75, 0%), or had unplanned admissions (OBA: 0/100, 0%; OFA: 0/75, 0%). Conclusions OFA provided equivalent pain control to OBA with faster recovery, supporting its use in outpatient pediatric dental surgery. Both approaches were safe, but OFA aligns with global opioid reduction efforts by minimizing opioid exposure.