Opioid-Sparing and Opioid-Free Anaesthesia: A Review of Clinical Evidence and Implementation Considerations

Opioid-induced side effects present substantial perioperative challenges, thereby driving the growing clinical adoption of opioid-sparing anaesthesia (OSA) and opioid-free anaesthesia (OFA) techniques. These multimodal strategies are designed to improve patient recovery while supporting responsible opioid stewardship. This review offers a practical overview of the principles, core techniques, and contemporary evidence for implementing OSA and OFA within routine hospital anaesthesia practice. Central to OSA/OFA is the integration of multimodal analgesia, which includes regional anaesthetic blocks, alpha-2 agonists, N-methyl-D-aspartate (NMDA) receptor antagonists, and gabapentinoids. Key advantages include reduced postoperative nausea and vomiting (PONV), faster return of bowel function, and markedly decreased opioid requirements. Effective implementation requires comprehensive patient education, individualized perioperative protocols, and coordinated interdisciplinary teamwork. OSA and OFA represent safe, effective, and increasingly essential strategies for perioperative pain management. Their broader integration can improve patient recovery outcomes, reduce opioid-related complications, and contribute to institutional medication-safety initiatives.