Giant primary synchronously bilateral mesenteric dedifferentiated liposarcoma with hyperparathyroidism, hyperthyroidism, type-2 diabetes mellitus and hypertension.

BACKGROUND

Opioid overprescription, especially after orthopedic surgery, contributes significantly to the ongoing opioid crisis. Despite limited benefit, opioids remain common for postoperative pain, increasing risks of addiction and adverse effects. Opioid-free (OF) analgesia offers a promising alternative. This meta-analysis examines the efficacy and safety of OF versus opioid-containing (OC) regimens for post-discharge orthopedic pain management.

METHOD: A systematic search identified randomized controlled trials (RCTs) comparing OF versus OC analgesia after surgical discharge in orthopedic procedures. A random-effects meta-analysis was performed.

RESULTS

13 RCTs involving 1,168 patients (588 OF, 580 OC) were included. The surgical procedures comprised arthroscopy (n = 5), hand and small joint surgery (n = 4), spine surgery (n = 2), extremity fracture repair (n = 1), and general ambulatory orthopedics (n = 1). Pain intensity, measured by Visual Analogue Scale (VAS), showed no statistically significant difference between groups on Day 1 (SMD -0.40; 95% CI: -0.85-0.06; P = 0.086) or Day 3 (SMD -0.93; 95% CI: -1.87-0.02; P = 0.055). However, the OF group demonstrated a statistically significant reduction in VAS scores on Days 4-7 (SMD -0.95; 95% CI: -1.88--0.03; P = 0.043). Regarding adverse events, there was no significant difference in overall incidence (RR 0.88; 95% CI: 0.67-1.16; P = 0.377) or nausea/vomiting rates (RR 0.73; 95% CI: 0.47-1.13; P = 0.155). However, the OF regimen significantly reduced the risk of constipation (RR 0.63; 95% CI: 0.43-0.92; P = 0.015).

CONCLUSIONS

This meta-analysis suggests that, for the examined procedures (predominantly arthroscopy and hand surgery), opioid use at discharge offers no pain control advantage over OF regimens and may increase adverse events. These results support the broader adoption of multimodal OF strategies in these specific contexts, though future research must validate these protocols in major trauma and complex reconstruction surgeries while identifying optimal patient candidates.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1007/s43465-026-01780-8.