Opioid-free versus opioid-based anesthesia for postoperative nausea and vomiting in laparoscopic cholecystectomy: A Systematic Review with Meta-Analysis, Meta-Regression and Trial Sequential Analysis.
João Paulo Aureliano de Carvalho, Pablo de Souza Ferreira, Elias Batista da Silva Neto et al.
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In 30 seconds
This systematic review and meta-analysis pooled 10 randomized controlled trials involving 1065 patients undergoing laparoscopic cholecystectomy to compare opioid-free with opioid-based anesthesia. Opioid-free anesthesia was associated with lower postoperative nausea and vomiting (PONV; RR = 0.30; 95% CI 0.18-0.48; p < 0.001). Pain scores were also lower at 2 and 8 hours, but not at 24 hours. Intraoperative hypotension was less frequent, while bradycardia, rescue analgesia, and opioid consumption within 24 hours did not differ. The authors rated the evidence for reduced PONV as moderate certainty.
Key findings
- PONV was reduced with opioid-free anesthesia (RR = 0.30; 95% CI 0.18-0.48; p < 0.001).
- Pain scores were lower at 2 h (MD = -0.72; 95% CI -1.05 to -0.39; p < 0.001) and 8 h (MD = -0.83; 95% CI -1.20 to -0.46; p < 0.001), but not at 24 h.
- Intraoperative hypotension was significantly reduced; bradycardia, rescue analgesia, and opioid consumption within 24 h showed no detected differences.
Why it matters
PONV is a frequent complication after laparoscopic cholecystectomy, and this pooled evidence suggests an anesthesia approach that may reduce it without worsening measured postoperative analgesia. The early pain-score differences and lower hypotension incidence add relevant perioperative outcomes, while the absence of differences in several other measures helps define the scope of the reported benefit.
What to keep in mind
The review included only 10 trials and 1065 patients; the abstract does not report follow-up beyond 24 h for the outcomes described.