MULTIMODAL ANALGESIA AND OPIOID-SPARING STRATEGIES: A SYSTEMATIC REVIEW IN THE PERIOPERATIVE CONTEXT

Abstract

DOI: https://doi.org/10.46296/gt.v8i16.0302

Abstract

Introduction: The global opioid crisis has led to the adoption of multimodal analgesia strategies aimed at reducing opioid use without compromising pain control. Multimodal analgesia with an opioid-sparing approach combines non-opioid drugs and regional techniques to reduce opioid consumption and its adverse effects. Objective: To synthesize recent evidence on the clinical applications of multimodal analgesia and opioid-sparing strategies in the perioperative period, describing their impact on opioid consumption, pain control, and postoperative outcomes. Methods: A systematic review was designed following the PRISMA 2020 recommendations. Studies were searched in PubMed, Embase, Web of Science, and Cochrane Library until November 2025, using combinations of the terms “multimodal analgesia,” “opioid-sparing,” “opioid-free anesthesia,” and “enhanced recovery after surgery.” Randomized clinical trials, systematic reviews, high-quality observational studies, and clinical practice guidelines in adults undergoing major surgery were included. For this synthesis, 13 key sources were prioritized for their methodological rigor, timeliness, and clinical impact. Results: The evidence shows that opioid-sparing strategies consistently reduce postoperative morphine equivalent consumption in the first 24 hours, improve or maintain pain scales, and decrease the incidence of nausea, vomiting, and pruritus, without increasing serious complications. The combination of paracetamol, nonsteroidal anti-inflammatory drugs, adjuvants (ketamine, gabapentinoids, α2 agonists), and regional techniques allows for analgesia protocols with minimal opioid use in orthopedic, colorectal, cardiac, and neurosurgical procedures. International guidelines recommend multimodal analgesia as a pillar of enhanced recovery after surgery. Conclusions: Multimodal analgesia with an opioid-sparing approach is an effective and safe strategy for optimizing the management of acute postoperative pain, reducing opioid exposure, and promoting functional recovery. Its implementation requires standardized protocols, training of the multidisciplinary team, and structured monitoring of opioid consumption and its adverse effects.

Keywords: Opioids, Anesthesiology, Updated regimen.