ASRA Conference Coverage

Opioid-Free Anesthesia Reduces Opioid Use in Shoulder Arthroplasty

Miranda Manier, BA

Key Highlights

  • Opioid-free anesthesia (OFA) significantly reduced intraoperative and post-anesthesia care unit (PACU) opioid use compared with opioid-based anesthesia (OBA).
  • 60% of patients receiving OFA required no opioids during hospitalization.
  • Patients who underwent OFA had significantly lower pain scores at discharge.
  • No increase in postoperative complications was observed in the OFA group.

In a prospective study of patients undergoing total shoulder arthroplasty, opioid-free anesthesia (OFA) was associated with significantly reduced perioperative opioid use and lower pain scores at discharge compared with conventional opioid-based anesthesia (OBA). This study will be presented on May 2, 2025, at the 50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting.

As the opioid crisis continues to prompt shifts in perioperative pain management, reducing opioid exposure during surgery has become a key focus. While regional anesthesia and multimodal analgesia have reduced the need for opioids, the complete elimination of intraoperative opioids remains relatively uncommon. This study aimed to assess the efficacy and safety of an OFA protocol in total shoulder arthroplasty—a high-pain procedure traditionally reliant on opioid-based regimens.

In this prospective, single-center trial, 60 patients scheduled for elective total shoulder arthroplasty were divided into two equal groups: 30 patients received OFA and 30 received OBA. All patients received a preoperative interscalene nerve block for regional analgesia. The OFA protocol utilized agents such as dexmedetomidine, ketamine, lidocaine, and magnesium in lieu of opioids, while the OBA group followed a conventional anesthetic protocol incorporating opioids. Key outcomes included intraoperative opioid use, PACU, opioid consumption, hospital opioid requirements, pain scores at discharge, and postoperative complications.

Compared with the OBA group, patients who underwent OFA required no opioids intraoperatively (median 0 vs 61.5 MME; P < .001) and used significantly less opioid medication in the PACU (median 0 vs 6 MME; P < .001). Overall, 60% of patients in the OFA group required no opioids at any point during hospitalization. At discharge, pain scores were significantly lower in the OFA group (median NRS 2 vs 4; P < .001). There were no statistically significant differences in postoperative complications, recovery time, or patient satisfaction between the two groups.

“Opioid-free anesthesia reduces in-hospital opioid use and improves pain scores following total shoulder arthroplasty,” the authors concluded.

Reference

Mountjoy R, Berg A, Compton M, et al. Opioid-free anesthesia reduces in-hospital opioid use and improves pain scores following total shoulder arthroplasty. Presented at: 50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting; May 2, 2025; Orlando, FL. https://asra.com/events-education/ra-acute-meeting