Opioid-free versus opioid-based anesthesia for postoperative nausea and vomiting in laparoscopic cholecystectomy: A Systematic Review with Meta-Analysis, Meta-Regression and Trial Sequential Analysis - 05/10/26

Doi : 10.1016/j.accpm.2026.101860

João Paulo Aureliano de Carvalho ^a,⁎ , Pablo de Souza Ferreira ^a, Elias Batista da Silva Neto ^a, Helen dos Reis Requião ^a, Liana Maria Tôrres de Araújo Azi ^a, Norma Sueli Pinheiro Módolo ^b, Rodrigo Leal Alves ^a,^b

^a Federal University of Bahia, Salvador, Brazil

^b Botucatu Medical School, São Paulo State University, Botucatu, Brazil

^⁎ Corresponding author.

Highlights

•	Opioid-free anesthesia reduces postoperative nausea and vomiting after cholecystectomy.
•	Provides better early postoperative pain control and less need for rescue analgesia.
•	Associated with lower incidence of intraoperative hypotension compared with opioids.
•	Maintains safety without increasing bradycardia or postoperative opioid consumption.

Le texte complet de cet article est disponible en PDF.

Abstract

Background

Postoperative nausea and vomiting (PONV) are frequent complications following laparoscopic cholecystectomy. Opioid-free anesthesia has emerged as a potential alternative to opioid-based anesthesia to reduce its occurrence. In this context, we performed a systematic review to compare the incidence of PONV between these two anesthesia alternatives, as well as to evaluate postoperative pain control and intraoperative hemodynamic stability.

Methods

This systematic review was conducted in accordance with PRISMA guidelines (CRD420251068278). Searches were performed in PubMed, Embase, Scopus, and the Cochrane Library, and included only randomized controlled trials. The quality of evidence was assessed using the GRADE system.

Results

Ten trials, including 1065 patients, were analyzed. Opioid-free anesthesia was associated with a significant reduction in PONV (RR = 0.30; 95% CI 0.18–0.48; p < 0.001). Postoperative pain, by the Numeric Rating Scale, was lower in the opioid-free group at 2 h (MD = −0.72; 95% CI −1.05 to −0.39; p < 0.001) and 8 h (MD = −0.83; 95% CI −1.20 to −0.46; p < 0.001), whereas no differences were detected at 24 h (MD = −0.16; 95% CI −0.40 to 0.07; p = 0.177). The incidence of intraoperative hypotension was significantly reduced in the opioid-free group. No differences were observed for bradycardia, need for rescue analgesia, or opioid consumption within 24 h.

Conclusions

The available pooled evidence in the literature indicates, with moderate certainty, that opioid-free anesthesia reduces PONV without compromising postoperative analgesia or intraoperative hemodynamic stability in patients undergoing laparoscopic cholecystectomy.

Le texte complet de cet article est disponible en PDF.

Keywords : Laparoscopic cholecystectomy, Meta-analysis, Opioid, Postoperative nausea and vomiting, Postoperative pain, Systematic review