Safety and Effectiveness of Multimodal Opioid-Free Anesthesia for Pain and Recovery after Laparoscopic Surgery: A Systematic Review and Meta- Analysis

Background: Multimodal Opioid-free anesthesia (OFA), a new anesthetic strategy, is always controversial for relieving postoperative pain in patients undergoing laparoscopy. The aim of this study was to investigate the safety and effectiveness of OFA compared to conventional opioid anesthesia (OA) in postoperative pain management and recovery in patients undergoing laparoscopic surgery. Methods This systematic review is registered on PROSPER. The databases of PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to September 2023. The study selection, data extraction, and risk of bias assessment were independently conducted by two reviewers. The primary outcomes included postoperative pain scores at 2h and 24h, postoperative analgesic consumption, Quality of recovery (QoR-40) scores, and the incidence of Postoperative Nausea and Vomiting (PONV) and other complications. The risk of bias was assessed using RoB 2.0, and meta-analysis was carried out using random effects models. Results Ultimately, 12 studies involving 983 patients undergoing laparoscopic surgery were included in this systematic evaluation and meta-analysis. The results of the meta-analysis showed that OFA significantly reduced early postoperative pain response in laparoscopic patients compared with conventional OA. OFA also reduced the incidence of PONV and the consumption of analgesics and antiemetics and improved the subjective quality of recovery in patients. The other variables presented no significant differences between the groups or were unable to be analyzed. Conclusions OFA may be more beneficial for postoperative pain management and recovery in patients undergoing laparoscopic surgery compared with conventional OA. Future studies could further extend these findings to other surgical populations.