Opiod-free anesthesia: the importance of evidence synthesis despite heterogeneity

We thank Dr. Tuhin Mistry [1], Dr. Abhijit Sukumaran Nair [1], and Dr. Mulier [2], and colleagues for their interest in our work and for their comments, which provided us with the opportunity to further discuss the methodology and implications of our network meta-analysis [3]. One of the most common definitions of opioid-free anesthesia (OFA) is “a practice that completely excludes the use of intraoperative systemic, neuraxial, or intracavitary opioids [4].” The OFA cultural paradigm is based on the idea that using opioids as intraoperative analgesics might increase adverse events such as respiratory depression, nausea and vomiting, acute tolerance, hyperalgesia, pain chronification, and subsequent chronic opioid use [5].