Opioid-free anaeshtesia in gynecology, future or a step back? –systematic review

Abstract

Gynecological operations are surgical procedures involving the pelvic organs of a woman. They are divided into:laparoscopic, laparotomy and from vaginal access. The first two types are performed under general anesthesiawith opioids (Opioid Based Anasthesia, OBA). However, due to many side effects of opioids, non-opioid anesthesia(Opioid Free Anasthesia, OFA) has become more widely used. The following review focuses on the comparisonof postoperative pain, analgesic consumption, recovery quality, nausea and vomiting (PONV), hypotension andbradycardia between these two therapeutic approaches. The aim of this study is to perform comparative analysis ofthe effectiveness and side effects in gynecological surgeries using the OFA or OBA procedure. Review was performedwith MEDLINE, EMBASE, AMED databeses and the Cochrane Library, between September 2023 and December 2023.Randomised controlled trials (RCTs) comparing efficacy and side effects between OFA and OBA were included. Thereview comprised 498 patients from 6 RCTs. Common interventions included laparoscopic procedures. Evidence showsa reduction in side effects in OFA. PONV frequency was reduced in OFA (RR = 0.52; 95% CI: 0.29–0.93; p = 0.004;l2 = 67.5%). The score on the recovery quality questionnaire was also significantly higher (mean difference +28.36 points/200). The difference in pain, frequency of hypotension and bradycardia slightly favors OFA, but these changeswere not statistically significant. OFA procedure is not only an effective alternative to OBA in gynecological surgery, butalso improves the outcomes after it. Although, further research in this field is required.