Opioid-sparing Strategies in Perioperative Pain Management: Current Evidence, Challenges, and Future Directions

Background: The global opioid epidemic has highlighted the need for safer perioperative pain management strategies to reduce opioid consumption and its associated complications. Opioid-sparing techniques, encompassing multimodal analgesia, regional anesthesia, and non-pharmacological interventions, provide effective pain control while minimizing the risks of addiction, overdose, and adverse effects such as respiratory depression and postoperative nausea and vomiting (PONV).

Objectives: This review aims to synthesize the current evidence on opioid-sparing techniques, evaluate their efficacy in perioperative pain management, and identify challenges and future directions for their implementation.

Methods: A narrative review was conducted using evidence from clinical trials, systematic reviews, and observational studies to examine pharmacological, regional, and non-pharmacological strategies. The barriers to implementation and emerging innovations in pain management were also explored.

Findings: Multimodal analgesia, incorporating NSAIDs, acetaminophen, NMDA receptor antagonists (e.g., ketamine), alpha-2 agonists (e.g., dexmedetomidine), lidocaine infusions, and gabapentinoids, effectively reduces pain and opioid consumption across various surgical contexts. Regional anesthesia techniques, such as neuraxial and peripheral nerve blocks, enhance pain relief and recovery outcomes while minimizing systemic opioid use. Non-pharmacological interventions, including TENS, acupuncture, and cognitive-behavioral therapy (CBT), further support opioid-sparing strategies by addressing pain through alternative mechanisms.

Despite their proven benefits, barriers such as resource limitations, knowledge gaps among clinicians, and variability in patient responses hinder their widespread adoption. Education, policy reform, and technological innovations, such as digital pain management tools and artificial intelligence (AI), are critical for overcoming these challenges.

Conclusion: Opioid-sparing strategies represent a fundamental change in perioperative care, improving pain management outcomes while mitigating the risks associated with opioid use. Interdisciplinary collaboration between anesthesiologists, surgeons, and policymakers is essential to expanding the adoption of these techniques, fostering safer and more effective perioperative pain management practices.