{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:56:08Z","timestamp":1792176968889,"version":"4.4.0"},"reference-count":32,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Concerns about opioid\u2010related adverse effects have increased interest in opioid\u2010free anaesthesia, but the benefits compared with opioid\u2010inclusive techniques, especially in the presence of regional anaesthesia, remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We undertook a systematic review with a network meta\u2010analysis of randomised controlled trials comparing six strategies in adults: opioid\u2010free anaesthesia and opioid\u2010inclusive anaesthesia using remifentanil alone or other opioids, each with or without regional anaesthesia. Primary outcome was postoperative pain. Secondary outcomes were: postoperative opioid use; post\u2010anaesthesia care unit discharge time; hospital duration of stay; and incidence of complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 885 trials from 59 countries. Techniques incorporating regional anaesthesia consistently ranked highest for postoperative pain. Regional anaesthesia combined with an opioid\u2010free intra\u2010operative strategy achieved some of the highest surface under the cumulative ranking curve values for pain at 2\u2009h, 12\u2009h and 48\u2009h (93%, 85% and 75%, all low certainty). When regional anaesthesia was used, differences between opioid\u2010free and opioid\u2010inclusive techniques were minimal (moderate certainty). For opioid consumption, regional anaesthesia with an opioid\u2010free strategy ranked best at 2\u2009h (moderate certainty), 12\u2009h (low certainty) and 48\u2009h (low certainty), with surface under the cumulative ranking curve values &gt;\u200998%. Techniques without regional anaesthesia were associated with higher pain scores and greater opioid requirements. Opioid\u2010free approaches, especially when combined with regional techniques, were associated with lower rates of postoperative nausea and vomiting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Regional anaesthesia was the key determinant of improved postoperative pain control, and intra\u2010operative opioids added little additional benefit when regional techniques provided adequate coverage. Without regional anaesthesia, neither opioid\u2010free nor opioid\u2010inclusive strategies showed consistent analgesic superiority. However, opioid\u2010free techniques reduced postoperative nausea and vomiting. These findings support preferential use of regional anaesthesia where feasible and suggest that avoiding intra\u2010operative opioids may facilitate recovery, particularly when regional techniques are employed effectively.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70121","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T09:29:44Z","timestamp":1767605384000},"page":"702-712","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Opioid\u2010free vs. opioid\u2010inclusive anaesthesia with or without regional anaesthesia for postoperative pain: a systematic review with network meta\u2010analysis of randomised controlled trials"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6482-5453","authenticated-orcid":false,"given":"Cl\u00edstenes C.","family":"de Carvalho","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Peri\u2010operative Medicine Guy's and St Thomas' NHS Foundation Trust  London UK"},{"name":"Academic Unit of Medicine Federal University of Campina Grande  Campina Grande Brazil"},{"name":"Department of Surgical Specialties and Anaesthesiology S\u00e3o Paulo State University, Medical School  Botucatu Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kariem","family":"El\u2010Boghdadly","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Peri\u2010operative Medicine Guy's and St Thomas' NHS Foundation Trust  London UK"},{"name":"Centre for Human and Applied Physiological Sciences King's College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Idrys H. L.","family":"Guedes","sequence":"additional","affiliation":[{"name":"Centre for Biological and Health Sciences Federal University of Campina Grande  Campina Grande Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Vit\u00f3ria M.","family":"Dantas","sequence":"additional","affiliation":[{"name":"Centre for Biological and Health Sciences Federal University of Campina Grande  Campina Grande Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danusa P. B.","family":"Tom\u00e9","sequence":"additional","affiliation":[{"name":"Centre for Biological and Health Sciences Federal University of Campina Grande  Campina Grande Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella B.","family":"Ramos","sequence":"additional","affiliation":[{"name":"Centre for Biological and Health Sciences Federal University of Campina Grande  Campina Grande Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clarissa S. 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