Perioperative Opioid Administration: A Critical Review of Opioid-free versus Opioid-sparing Approaches

Harsha Shanthanna, Karim S. Ladha, Henrik Kehlet, Girish P. Joshi

Research output: Contribution to journalReview articlepeer-review

66 Scopus citations


Opioids form an important component of general anesthesia and perioperative analgesia. Discharge opioid prescriptions are identified as a contributor for persistent opioid use and diversion. In parallel, there is increased enthusiasm to advocate opioid-free strategies, which include a combination of known analgesics and adjuvants, many of which are in the form of continuous infusions. This article critically reviews perioperative opioid use, especially in view of opioid-sparing versus opioid-free strategies. The data indicate that opioid-free strategies, however noble in their cause, do not fully acknowledge the limitations and gaps within the existing evidence and clinical practice considerations. Moreover, they do not allow analgesic titration based on patient needs; are unclear about optimal components and their role in different surgical settings and perioperative phases; and do not serve to decrease the risk of persistent opioid use, thereby distracting us from optimizing pain and minimizing realistic long-term harms.

Original languageEnglish (US)
Article number003572
Pages (from-to)645-659
Number of pages15
StateAccepted/In press - 2021

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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