TOPLINE:

In patients undergoing surgery, regional anesthesia minimizes the use of opioids and is linked to smoother recovery, such as shorter hospital stays and reduced odds of postoperative nausea and vomiting.

METHODOLOGY:

• Researchers conducted a systematic review and network meta-analysis of 885 randomized controlled trials from 59 countries to evaluate the safety and effectiveness of different anesthetic strategies in patients aged 16 years or older undergoing surgery.
• The study compared six anesthetic strategies, including opioid-free and opioid-inclusive techniques (using remifentanil alone or other opioids), with or without local/regional anesthesia.
• The primary outcome was postoperative pain; secondary outcomes included postoperative opioid consumption, time to discharge from the postanesthesia care unit, postoperative complications, and other variables.
• Timepoints that were most frequently reported were selected: 2, 12, 24, and 48 hours after surgery.
• Surface under the cumulative ranking curve (SUCRA) values were calculated to determine the probability of effectiveness of each anesthetic intervention.

TAKEAWAY:

• Techniques without regional anesthesia were associated with poor pain control, whereas those with regional anesthesia showed similar pain control regardless of the use of opioids and ranked highest across all timepoints.
• Opioid-free anesthesia with regional techniques ranked best in minimizing the consumption of opioids at 2, 12, and 48 hours, with SUCRA values exceeding 98%. Opioid-inclusive anesthesia without and with regional techniques was linked to longer hospital stays (mean difference, 15.67 hours).
• Opioid-free anesthesia with regional techniques was associated with the lowest odds of postoperative nausea and vomiting, with a SUCRA value of 99%. In combination with regional techniques, opioid-free and opioid-inclusive anesthesia was linked to reduced odds of postoperative nausea and vomiting (odds ratio [OR], 0.54; 95% credible interval [CrI], 0.41-0.71).
• Opioid-inclusive and remifentanil-only anesthesia, both without regional techniques, were associated with higher odds of postoperative nausea and vomiting (OR, 2.25; 95% CrI, 1.98-2.56 and OR, 2.10; 95% CrI, 1.35-3.12, respectively).

IN PRACTICE:

The study “underscores the pivotal role of regional anesthesia in improving postoperative outcomes and suggests that the assumed necessity of intraoperative opioids may warrant reconsideration in many clinical contexts. When effective regional anesthesia with adequate coverage and duration is feasible, opioid-free strategies appear to provide a favorable balance of analgesia, reduced opioid use, and fewer complications and may represent a useful strategy in contemporary perioperative care,” the researchers wrote.

SOURCE:

The study was led by Clístenes C. de Carvalho, of the Department of Anaesthesia and Perioperative Medicine at the Guy’s and St Thomas’ NHS Foundation Trust in London, England. It was published online on January 5, 2026, in Anaesthesia.

LIMITATIONS:

The certainty of evidence for many comparisons was low owing to clinical and methodological heterogeneity, imprecision, and potential publication bias. Opioid-sparing approaches were not analyzed separately, which may hinder specific conclusions. The variety of opioid-free techniques may have contributed to the heterogeneity.

DISCLOSURES:

One author declared receiving a research fellowship from the Brazilian public agency CNPq. Another author reported receiving funding from Fisher and Paykel Healthcare Ltd, PAION, GE Healthcare, and Edwards Lifesciences. No external funding or other competing interests were declared.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.