Is opioid-free general anesthesia for breast and gynecological surgery a viable option?

Abstract

Opioid-free anesthesia (OFA) was introduced to avoid tolerance and hyperalgesia, allowing reduction in postoperative opioids. OFA focused initially on postoperative respiratory safety for patients undergoing ambulatory surgery and for obstructive sleep apnea syndrome patients otherwise requiring intensive care admission. What about using OFA in plastic and oncological breast surgery, in deep inferior epigastric perforators flap surgery, and in gynecological laparoscopy? OFA requires the use of other drugs to block the unwanted reactions from surgical injury. This can be achieved with a single drug at a high dose or with a combination of different drugs at a lower dose, such as with alpha-2-agonists, ketamine, lidocaine, and magnesium, each working on a different target and therefore described as multitarget anesthesia. Three factors can explain OFA success: improved analgesia with less postoperative opioids, the near absence of postoperative nausea and vomiting if no opioid is needed postoperatively, and reduced inflammation enhancing the recovery after surgery. Opioid-free general anesthesia is a viable option for breast and gynecological surgery and its use will only increase when anesthesiologists listen to their patients' experiences after undergoing surgery under general anesthesia.