{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T16:32:35Z","timestamp":1790353955515,"version":"4.1.0"},"reference-count":53,"publisher":"Elsevier BV","issue":"11","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","jcardioanesthesia.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Journal of Cardiothoracic and Vascular Anesthesia"],"published-print":{"date-parts":[[2025,11]]},"DOI":"10.1053\/j.jvca.2025.06.040","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T11:21:43Z","timestamp":1751023303000},"page":"3140-3153","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":18,"title":["Opioid-sparing Anesthesia in Cardiac Surgery: A Meta-analysis"],"prefix":"10.1053","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9718-7454","authenticated-orcid":false,"given":"Michela","family":"Rauseo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Mirabella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo Antonio","family":"Carrideo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Paolo","family":"Padovano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonarda Pia","family":"Cantatore","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Vetuschi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Da Lima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Paternoster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilda","family":"Cinnella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1053\/j.jvca.2025.06.040_bib0001","article-title":"Pain management and opioid stewardship in adult cardiac surgery: Joint consensus report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery\u2013Cardiac Society","volume":"165","author":"Grant","year":"2023","journal-title":"J Thorac Cardiovasc Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0002","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1001\/jamacardio.2020.1445","article-title":"Development of persistent opioid use after cardiac surgery","volume":"5","author":"Brown","year":"2020","journal-title":"JAMA Cardiol"},{"key":"10.1053\/j.jvca.2025.06.040_bib0003","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.surg.2019.04.016","article-title":"New persistent opioid use among older patients following surgery: A Medicare claims analysis","volume":"167","author":"Santosa","year":"2020","journal-title":"Surgery"},{"key":"10.1053\/j.jvca.2025.06.040_bib0004","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1002\/wjs.12122","article-title":"Enhanced recovery protocols after surgery: A systematic review and meta-analysis of randomized trials in cardiac surgery","volume":"48","author":"Spadaccio","year":"2024","journal-title":"World J Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0005","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1001\/jamasurg.2019.1153","article-title":"Guidelines for perioperative care in cardiac surgery: Enhanced Recovery After Surgery Society recommendations","volume":"154","author":"Engelman","year":"2019","journal-title":"JAMA Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0006","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/1471-2288-14-135","article-title":"Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range","volume":"14","author":"Wan","year":"2014","journal-title":"BMC Med Res Methodol"},{"key":"10.1053\/j.jvca.2025.06.040_bib0007","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"10.1053\/j.jvca.2025.06.040_bib0008","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s13643-024-02464-w","article-title":"Synthesis methods used to combine observational studies and randomised trials in published meta-analyses","volume":"13","author":"Cheurfa","year":"2024","journal-title":"Syst Rev"},{"key":"10.1053\/j.jvca.2025.06.040_bib0009","first-page":"1","article-title":"Risk-of-bias VISualization (robVis): An R package and Shiny web app for visualizing risk-of-bias assessments","volume":"12","author":"McGuinness","year":"2020","journal-title":"Res Syn Meth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0010","first-page":"71","article-title":"Lower dose of sufentanil was associated with higher plasmatic level of cortisol in patients undergoing elective cardiac surgery at the same depth of anaesthesia: A prospective randomised pilot study. Do we overlook \u201cstress under the surface?\u201d","volume":"20","author":"Rogozov","year":"2024","journal-title":"Signa Vitae"},{"key":"10.1053\/j.jvca.2025.06.040_bib0011","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1053\/j.jvca.2018.11.021","volume":"33","author":"Macaire","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0012","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.xjon.2024.08.007","article-title":"Multimodal analgesia with parasternal plane block within an ERAS program","volume":"22","author":"Darras","year":"2024","journal-title":"JTCVS Open"},{"key":"10.1053\/j.jvca.2025.06.040_bib0013","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1007\/s12630-023-02637-6","article-title":"Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing minimally invasive direct coronary artery bypass surgery: A double-blinded randomized controlled trial","volume":"71","author":"Xin","year":"2024","journal-title":"Can J Anesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0014","first-page":"33","article-title":"Multimodal opioid-free anesthesia versus opioid-based anesthesia for patients undergoing cardiac valve surgeries: A randomized controlled trial","volume":"8","author":"Elgendy","year":"2024","journal-title":"Bali J Anesthesiol"},{"key":"10.1053\/j.jvca.2025.06.040_bib0015","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1053\/j.jvca.2020.02.035","article-title":"Perioperative dexmedetomidine supplement decreases delirium incidence after adult cardiac surgery: A randomized, double-blind, controlled study","volume":"35","author":"Likhvantsev","year":"2021","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0016","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1016\/j.athoracsur.2021.10.005","article-title":"Predictors of discharge home without opioids after cardiac surgery: A multicenter analysis","volume":"114","author":"Wagner","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0017","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/j.athoracsur.2019.12.031","article-title":"New persistent opioid use after aortic and mitral valve surgery in commercially insured patients","volume":"110","author":"Clement","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0018","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1016\/j.athoracsur.2020.01.042","article-title":"What drives opioid prescriptions after cardiac surgery: Practice or patient?","volume":"110","author":"Holst","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0019","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s13019-022-01815-9","article-title":"Fast tracking in cardiac surgery: Is it safe?","volume":"17","author":"MacLeod","year":"2022","journal-title":"J Cardiothorac Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0020","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1016\/j.athoracsur.2020.11.015","article-title":"Establishment and implementation of evidence-based opioid prescribing guidelines in cardiac surgery","volume":"112","author":"Brescia","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0021","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.athoracsur.2021.04.030","article-title":"The incidence of new persistent opioid use following cardiac surgery via sternotomy","volume":"113","author":"Ingason","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0022","doi-asserted-by":"crossref","DOI":"10.3389\/fmed.2023.1243311","article-title":"Opioid-free anesthesia reduces the severity of acute postoperative motion-induced pain and patient-controlled epidural analgesia-related adverse events in lung surgery: Randomized clinical trial","volume":"10","author":"Wang","year":"2023","journal-title":"Front Med"},{"key":"10.1053\/j.jvca.2025.06.040_bib0023","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1053\/j.jvca.2016.02.010","article-title":"Intravenous acetaminophen as an adjunct analgesic in cardiac surgery reduces opioid consumption but not opioid-related adverse effects: A randomized controlled trial","volume":"30","author":"Jelacic","year":"2016","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0024","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1053\/j.jvca.2022.12.023","article-title":"The association between enhanced recovery after cardiac surgery\u2013guided analgesics and postoperative delirium","volume":"37","author":"Jelly","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0025","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12871-019-0802-y","article-title":"Effect of opioid-free anaesthesia on post-operative period in cardiac surgery: A retrospective matched case-control study","volume":"19","author":"Guinot","year":"2019","journal-title":"BMC Anesthesiol"},{"key":"10.1053\/j.jvca.2025.06.040_bib0026","first-page":"346","article-title":"Remifentanil and sevoflurane based anesthesia combined with bilateral erector spinae plane block in patients undergoing off-pump coronary artery bypass graft surgery","volume":"15","author":"Kurowicki","year":"2020","journal-title":"Wideochir Inne Tech Maloinwazyjne"},{"key":"10.1053\/j.jvca.2025.06.040_bib0027","first-page":"678","article-title":"Postoperative analgesia efficacy of erector spinae plane block in patients submitted to cardiac surgery: Randomized clinical trial","volume":"72","author":"Silva","year":"2022","journal-title":"Braz J Anesthesiol"},{"key":"10.1053\/j.jvca.2025.06.040_bib0028","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1016\/j.athoracsur.2021.06.072","article-title":"Cardiac enhanced recovery after surgery: Early outcomes in a community setting","volume":"113","author":"Salenger","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0029","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.xjon.2022.08.008","article-title":"Enhanced recovery after cardiac surgery protocol reduces perioperative opioid use","volume":"12","author":"Loria","year":"2022","journal-title":"JTCVS Open"},{"key":"10.1053\/j.jvca.2025.06.040_bib0030","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.3390\/jcm14051768","article-title":"Enhanced Recovery After Surgery (ERAS) protocols in cardiac surgery: Impact on opioid consumption","volume":"14","author":"Othenin-Girard","year":"2025","journal-title":"J Clin Med"},{"key":"10.1053\/j.jvca.2025.06.040_bib0031","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1186\/s12871-021-01362-1","article-title":"Feasibility and postoperative opioid sparing effect of an opioid-free anaesthesia in adult cardiac surgery: A retrospective study","volume":"21","author":"Aguerreche","year":"2021","journal-title":"BMC Anesthesiol"},{"key":"10.1053\/j.jvca.2025.06.040_bib0032","doi-asserted-by":"crossref","first-page":"10","DOI":"10.5114\/ait.2020.93160","article-title":"Implementation of Enhanced Recovery After Surgery (ERAS) protocol in off-pump coronary artery bypass graft surgery. A prospective cohort feasibility study","volume":"52","author":"Borys","year":"2020","journal-title":"Anaesthesiol Intensive Ther"},{"key":"10.1053\/j.jvca.2025.06.040_bib0033","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1186\/s13019-025-03405-x","article-title":"Ketamine as part of multi-modal analgesia may reduce opioid requirements following cardiac surgery: A retrospective observational cohort study","volume":"20","author":"Hall","year":"2025","journal-title":"J Cardiothorac Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0034","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1186\/s13019-022-02067-3","article-title":"The impact of a postoperative multimodal analgesia pathway on opioid use and outcomes after cardiothoracic surgery","volume":"17","author":"Ward","year":"2022","journal-title":"J Cardiothorac Surg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0035","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1213\/ANE.0000000000005152","article-title":"Opioid-sparing cardiac anesthesia: Secondary analysis of an enhanced recovery program for cardiac surgery","volume":"131","author":"Grant","year":"2020","journal-title":"Anesth Analg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0036","doi-asserted-by":"crossref","first-page":"i16","DOI":"10.1093\/bja\/aeq312","article-title":"Dose adjustment of anaesthetics in the morbidly obese","volume":"105","author":"Ingrande","year":"2010","journal-title":"Br J Anaesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0037","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1213\/ANE.0000000000005238","article-title":"Enhanced recovery after cardiac surgery: Are more (and which) opioid-sparing interventions better?","volume":"131","author":"Maldonado","year":"2020","journal-title":"Anesth Analg"},{"key":"10.1053\/j.jvca.2025.06.040_bib0038","doi-asserted-by":"crossref","first-page":"349","DOI":"10.3390\/hearts5030025","article-title":"Multimodal analgesia strategies for cardiac surgery: A literature review","volume":"5","author":"Fernandes","year":"2024","journal-title":"Hearts"},{"key":"10.1053\/j.jvca.2025.06.040_bib0039","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.bja.2021.11.041","article-title":"Influence of perioperative dexmedetomidine on the incidence of postoperative delirium in adult patients undergoing cardiac surgery","volume":"129","author":"Patel","year":"2022","journal-title":"Br J Anaesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0040","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1053\/j.jvca.2020.09.103","article-title":"Reducing opioid use in patients undergoing cardiac surgery - Preoperative, intraoperative, and critical care strategies","volume":"35","author":"Ochroch","year":"2021","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0041","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1053\/j.jvca.2016.02.026","article-title":"The effect of dexmedetomidine on outcomes of cardiac surgery in elderly patients","volume":"30","author":"Cheng","year":"2016","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0042","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1053\/j.jvca.2018.10.012","article-title":"Opioid-free ultra-fast-track on-pump coronary artery bypass grafting using erector spinae plane catheters","volume":"33","author":"Chanowski","year":"2019","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0043","doi-asserted-by":"crossref","first-page":"70","DOI":"10.4103\/aca.ACA_113_18","article-title":"Enhanced recovery and early extubation after pediatric cardiac surgery using single-dose intravenous methadone","volume":"23","author":"Iguidbashian","year":"2020","journal-title":"Ann Card Anaesth"},{"key":"10.1053\/j.jvca.2025.06.040_bib0044","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.3390\/medicina60071036","article-title":"Intraoperative dexmedetomidine use for enhanced recovery after surgery (ERAS) in cardiac surgery-Single center retrospective observational cohort study","volume":"60","author":"Kerroum","year":"2024","journal-title":"Medicina (Kaunas)"},{"key":"10.1053\/j.jvca.2025.06.040_bib0045","first-page":"10","article-title":"Application of opioid-free general anesthesia in laparoscopy: A meta-analysis of randomized controlled studies","volume":"20","author":"Gao M-H","year":"2024","journal-title":"Signa Vitae"},{"key":"10.1053\/j.jvca.2025.06.040_bib0046","doi-asserted-by":"crossref","first-page":"10","DOI":"10.22514\/sv.2025.002","article-title":"Comparison of analgesic effects between erector spinae plane block and serratus anterior plane block in breast and thoracic surgery: A systemic review and meta-analysis","volume":"21","author":"Zhao P","year":"2025","journal-title":"Signa Vitae"},{"key":"10.1053\/j.jvca.2025.06.040_bib0047","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.bjae.2023.08.001","article-title":"Non-steroidal anti-inflammatory drugs in the perioperative period","volume":"23","author":"Halvey","year":"2023","journal-title":"BJA Educ"},{"key":"10.1053\/j.jvca.2025.06.040_bib0048","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1592\/phco.29.12.1492","article-title":"Dexmedetomidine-associated bradycardia progressing to pulseless electrical activity: Case report and review of the literature","volume":"29","author":"Gerlach","year":"2009","journal-title":"Pharmacotherapy"},{"key":"10.1053\/j.jvca.2025.06.040_bib0049","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1111\/j.1365-2044.2007.05298.x","article-title":"Ketamine","volume":"62","author":"Craven","year":"2007","journal-title":"Anaesthesia"},{"key":"10.1053\/j.jvca.2025.06.040_bib0050","article-title":"Systemic administration of local anesthetic agents to relieve neuropathic pain","volume":"2005","author":"Challapalli","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"10.1053\/j.jvca.2025.06.040_bib0051","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1097\/ALN.0000000000000633","article-title":"Intraoperative methadone for the prevention of postoperative pain: A randomized, double-blinded clinical trial in cardiac surgical patients","volume":"122","author":"Murphy","year":"2015","journal-title":"Anesthesiology"},{"key":"10.1053\/j.jvca.2025.06.040_bib0052","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1097\/ALN.0000000000002334","article-title":"Recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery-2018","volume":"129","author":"Evered","year":"2018","journal-title":"Anesthesiology"},{"key":"10.1053\/j.jvca.2025.06.040_bib0053","doi-asserted-by":"crossref","first-page":"316","DOI":"10.21470\/1678-9741-2022-0058","article-title":"Multimodal analgesia in paving the way for enhanced recovery after cardiac surgery","volume":"38","author":"Magoon","year":"2023","journal-title":"Braz J Cardiovasc Surg"}],"container-title":["Journal of Cardiothoracic and Vascular Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1053077025005361?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1053077025005361?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:40:06Z","timestamp":1760139606000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1053077025005361"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":53,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["S1053077025005361"],"URL":"https:\/\/doi.org\/10.1053\/j.jvca.2025.06.040","relation":{},"ISSN":["1053-0770"],"issn-type":[{"value":"1053-0770","type":"print"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Opioid-sparing Anesthesia in Cardiac Surgery: A Meta-analysis","name":"articletitle","label":"Article Title"},{"value":"Journal of Cardiothoracic and Vascular Anesthesia","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1053\/j.jvca.2025.06.040","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Author(s). Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}