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<p>Opioid analgesia is commonly employed in abdominal surgeries but is associated with adverse effects, including postoperative nausea and increased postoperative opioid consumption. With enhanced recovery after surgery (ERAS) protocols, opioid-sparing and opioid-free anesthesia arose as possible solutions for these issues. We conducted a systematic review and meta-analysis comparing opioid and opioid-sparing perioperative analgesia in minimally invasive colorectal surgeries. We searched Cochrane, Pubmed/MEDLINE, and EMBASE for comparative studies comparing opioid-free or opioid-sparing with opioid-based analgesic strategies for perioperative analgesia in minimally invasive colorectal procedures. Primary outcomes included pain, evaluated using the visual analog scale (VAS) at 24&#xa0;h and 48&#xa0;h postoperative, opioid consumption (morphine equivalents), and hospital length of stay (LOS). Secondary outcomes comprised complications (nausea, pruritus, overall complications, postoperative ileus, readmission, and mortality). Statistical analyses were performed using R software. Out of 1345 studies screened, 8 comparative studies were included for final analyses. These included 2 randomized controlled trials, encompassing 21,216 patients, with 1840 (8.6%) in the opioid-sparing group. No differences were found between the groups in postoperative pain at 24&#xa0;h (MD − 0.86; 95% CI [− 1.8 to 0.07]; <i>p</i> = 0.07) and 48&#xa0;h (MD − 0.77; 95% CI [− 1.6 to 0.04]; <i>p</i> = 0.06) after surgery. Opioid-sparing strategies reduced postoperative opioid consumption significantly (MD 29.7&#xa0;mg of morphine equivalents; 95% CI − 45.2 to − 14.1; <i>p</i> &lt; 0.001). No differences with statistical significance were found for overall postoperative complications, nausea, pruritus, ileus, readmission, or mortality rates. Opioid-sparing strategies showed a significant reduction in postoperative opioid consumption without differences in postoperative pain or complications, suggesting it can be an alternative to opioid-based analgesia in minimally invasive colorectal surgeries.</p>

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Optimizing pain management: a systematic review and meta-analysis of opioid-sparing and opioid-free analgesia in minimally invasive colorectal surgery

  • 期刊论文

  • 发表日期：

    2026年4月20日

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  • Kyle Leong,
  • Carlos A Balthazar da Silveira,
  • Harvey Wang,
  • Laura Cogua,
  • Nicole Salevitz,
  • Ana Caroline Rasador,
  • Conrad Ballecer,
  • Vikram Deka,
  • Thomas Gillespie

摘要

Opioid analgesia is commonly employed in abdominal surgeries but is associated with adverse effects, including postoperative nausea and increased postoperative opioid consumption. With enhanced recovery after surgery (ERAS) protocols, opioid-sparing and opioid-free anesthesia arose as possible solutions for these issues. We conducted a systematic review and meta-analysis comparing opioid and opioid-sparing perioperative analgesia in minimally invasive colorectal surgeries. We searched Cochrane, Pubmed/MEDLINE, and EMBASE for comparative studies comparing opioid-free or opioid-sparing with opioid-based analgesic strategies for perioperative analgesia in minimally invasive colorectal procedures. Primary outcomes included pain, evaluated using the visual analog scale (VAS) at 24 h and 48 h postoperative, opioid consumption (morphine equivalents), and hospital length of stay (LOS). Secondary outcomes comprised complications (nausea, pruritus, overall complications, postoperative ileus, readmission, and mortality). Statistical analyses were performed using R software. Out of 1345 studies screened, 8 comparative studies were included for final analyses. These included 2 randomized controlled trials, encompassing 21,216 patients, with 1840 (8.6%) in the opioid-sparing group. No differences were found between the groups in postoperative pain at 24 h (MD − 0.86; 95% CI [− 1.8 to 0.07]; p = 0.07) and 48 h (MD − 0.77; 95% CI [− 1.6 to 0.04]; p = 0.06) after surgery. Opioid-sparing strategies reduced postoperative opioid consumption significantly (MD 29.7 mg of morphine equivalents; 95% CI − 45.2 to − 14.1; p < 0.001). No differences with statistical significance were found for overall postoperative complications, nausea, pruritus, ileus, readmission, or mortality rates. Opioid-sparing strategies showed a significant reduction in postoperative opioid consumption without differences in postoperative pain or complications, suggesting it can be an alternative to opioid-based analgesia in minimally invasive colorectal surgeries.