Evidence map›Paper›PMID 42304211›Full record

SynthesisBMC anesthesiology2026

Impact of opioid free anesthesia on postoperative nausea and vomiting, chronic pain, and quality of recovery in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis of randomized controlled trials.

Jingchen Yang, Tianwu Liao, Jin Luo, Aixin Ma, Jincan He, Hao Li, Rongsheng Liu, Yang Yu, Jun Peng

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Jingchen Yang *The College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, 650500, China.
Tianwu Liao *The College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, 650500, China.
Jin LuoDepartment of Anaesthesiology, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, China.
Aixin MaThe College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, 650500, China.
Jincan HeThe College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, 650500, China.
Hao LiThe College of Medicine, Kunming University of Science and Technology, Kunming, Yunnan, 650500, China.
Rongsheng LiuDepartment of Thoracic Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, China.
Yang YuDepartment of Thoracic Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, China. yu4126@sina.com.
Jun PengDepartment of Thoracic Surgery, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, 650032, China. 9y140211@kust.edu.cn.

Funding

the Basic Research Program project ofYunnan Province 202501AY070001-115the Talent Project-Famous Doctor Project of Yunnan Province XDYCMY-2022-0029the Yunnan Provincial Department of science and Technology- Kunming Medical Universityjoint Project 202501AY070001-219the Yunnan Provincial Department of Science and Technology - Major Science and Technology Special Project 202402AA310016
6 · The paper itself

Abstract

backgroundOpioids are frequently used in general anesthesia but may delay recovery owing to adverse effects, which include respiratory depression, postoperative nausea and vomiting (PONV), and opioid-induced hyperalgesia. Opioid-free anesthesia (OFA), based on multimodal analgesia, offers an alternative to mitigate these issues and enhance recovery in thoracic surgery. However, high-quality evidence confirming its effectiveness and safety is needed.

methodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in this study. PubMed, Web of Science, Embase, and Cochrane Library were systematically searched from inception to March 01, 2025, for randomized controlled trials (RCTs) that compared OFA and opioid-based anesthesia (OBA) in patients undergoing video-assisted thoracoscopic surgery (VATS). Study titles, abstracts, and full texts were separately evaluated for eligibility by two researchers; disagreements were resolved by discussion or a third researcher. The Cochrane Risk of Bias tool was used to evaluate the risk of bias in included studies. Primary outcomes included PONV incidence and 24-h postoperative pain scores. Secondary outcomes included chronic pain, intraoperative hemodynamic events, length of stay in the recovery room, length of hospitalization, and quality of recovery (as measured by QoR-40/QoR-15).

resultsThis systematic review and meta-analysis consisted of 10 RCTs involving 1,106 patients. OFA reduced the risk of PONV (risk ratio (RR) = 0.41, 95% confidence interval (CI): 0.380-0.665) and the incidence of postoperative chronic pain at 3 months (RR = 0.566, 95% CI: 0.347-0.925), compared with OBA. However, the 24-h postoperative pain scores did not differ (MD = 0.082, p = 0.305). Bradycardia incidence was lower in the OFA group, but hypotension rates did not differ. The length of stay in recovery rooms and the length of hospitalization did not differ significantly. Although 24-h QoR-40 scores favored OFA (mean difference = 2.914, 95% CI: 1.017-4.811), this improvement did not reach the clinically established threshold of 6.3 points.

conclusionWithout worsening intraoperative hemodynamic instability or extending postoperative recovery, OFA significantly reduced the incidence of PONV and chronic pain in patients undergoing VATS. These results validate OFA as a potentially safe and effective anesthetic strategy for improving postoperative recovery after thoracic surgery. Further large-scale RCTs are warranted to standardize OFA protocols and validate its long-term advantages.

trial registrationRegistration of systematic reviews: CRD42025636410.

Indexed as

Chronic PainPostoperative Nausea and VomitingPostoperative PainThoracic Surgery, Video-AssistedAnalgesics, OpioidHumansRandomized Controlled Trials as TopicAnalgesics, OpioidEnhanced Recovery After SurgeryERASOpioid Free AnesthesiaVideo-Assisted Thoracoscopic Surgery

Identifiers

PMID42304211
PMCPMC13504770

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.