Adina Yerzhan

Background/Objectives: Opioid-free anesthesia (OFA) has emerged as a potential alternative to opioid-based anesthesia (OBA) to reduce opioid-related adverse effects. This meta-analysis compares OFA and OBA with respect to postoperative pain and opioid consumption. Methods: PubMed, Cochrane, and Embase libraries were searched for OFA studies published through 12 June 2025. Randomized controlled trials (RCTs) conducted on adult humans were selected; observational studies, studies including neuraxial anesthesia, and RCTs currently awaiting approval were excluded. A forest plot was used to summarize findings of a random-effects meta-analysis to compare OFA (treatment) and OBA (control). Results: Of 1446 citations found, twenty-nine articles met our inclusion criteria. Twenty-six studies reported pain scores with a 0–10 scale. OFA was associated with lower postoperative pain scores (Hedges’ g = –0.34; 95% CI –0.55 to –0.13; p < 0.001; I² = 84%) but with high heterogeneity, limiting clinical significance or strong interpretation of results. Eleven trials were analyzed for opioid use, showing a small reduction with OFA (Hedges’ g = –0.55; 95% CI –1.10 to –0.005; p = 0.048; I² = 96.22%). Subgroup outcomes favored OFA, with an overall reduction in pain found specifically in endoscopic abdominal surgeries. Some secondary outcomes also indicated potential improved recovery profiles through OFA for certain surgeries. Conclusions: OFA was associated with statistically significant lower postoperative pain scores, along with opioid consumption, but with a small effect size and high heterogeneity when compared to OBA. This is potentially comparable in pain control and opioid consumption with limited clinical significance. Overall, outcomes support the continued controlled study of OFA as an alternative to conventional analgesia.

Background/Objectives: In the current opioid crisis, medical hypnosis has been proposed as an alternative to opioids to control acute and chronic pain. The aim of this study was to use a meta-analysis to conduct an objective assessment of the value of medical hypnosis for the management of acute and chronic pain and opioid consumption. Methods: An initial PubMed search showed 111 relevant studies out of 1115. Twelve randomized controlled studies (RCTs) were identified, published from January 2014 to December 2024, focusing on acute and chronic pain. These RCTs were analyzed to compare the effects of medical hypnosis vs. standard care. Results: The use of medical hypnosis for acute pain was found to decrease pain by 0.54 standard deviations (SD) compared to the standard care, and the effect was medium and statistically significant (95% CI [0.19–0.90]; p = 0.0024). Oral morphine equivalents (OME) in the hypnosis group were 1.5 SD lower than in the placebo group, which was statistically significant (95% CI [0.12, 2.88]; p = 0.03). Unlike the effectiveness of hypnosis for acute pain treatment, hypnosis was not found to have any impact on the treatment of chronic pain. The mean pain value difference in the hypnosis group had little effect and showed a statistically insignificant result—a Hedges’ g score of 0.07 (95% CI [−0.14–0.27]; p = 0.518). Conclusions: The use of medical hypnosis was associated with a statistically significant decrease in acute pain scores and OME, suggesting it is a potential alternative to opioids, but our analysis indicates that hypnosis does not reduce chronic pain.