Opioid-free anesthesia

International audienceOpioid Free Anesthesia (OFA) is emerging as a new stimulating research perspective. The rationale to propose OFA is based on the aim to avoid the negative impact of intraoperative opioid on patient's postoperative outcomes and also on the physiology of pathways involved in intraoperative nociception. It is based on the concept of multimodal anesthesia. OFA has been shown to be feasible but the literature is still scarce on the clinically meaningful benefits for patients as well as on the side effects and / or complications that might be associated with it. This review focused first on the physiology of nociception, the reasons for using or not opioids during anesthesia, and then on the literature reporting evidence-based proofs of benefits / risks associated with OFA. Practice points: • OFA is a multimodal anesthesia associating drugs and/or techniques that allows a good quality general anesthesia with no need for opioids 2 • Anti-nociception during general anesthesia can be obtained by interfering with various neuromediators not only by interfering with enkephalins with opioids • Studies have shown that OFA allows a postoperative morphine sparing, PONV reduction and a trend towards a reduction of opioid-related adverse event