Effects of opioid-free and opioid-sparing anesthesia on postoperative delirium: A systematic review and meta-analysis.
Tingting Liu, Xiu Geng, Lijuan Wang et al.
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In 30 seconds
This systematic review and meta-analysis assessed opioid-free and opioid-sparing anesthesia for preventing postoperative delirium (POD) in adult surgical patients. It pooled 41 randomized controlled trials involving 7852 patients and found lower delirium risk with these strategies than with control regimens (RR = 0.641, 95% CI: 0.525-0.784; I2 = 52.2%). Subgroup analyses found a significant reduction with dexmedetomidine, while estimates for esketamine and ketamine did not establish a statistically significant benefit. The authors conclude that opioid-free and opioid-sparing approaches may reduce POD, with the most consistent subgroup benefit observed for dexmedetomidine.
Key findings
- POD occurred in 488 of 4013 patients receiving opioid-free/opioid-sparing interventions and 633 of 3839 controls.
- Across 41 trials, interventions reduced delirium risk (RR = 0.641, 95% CI: 0.525-0.784; I2 = 52.2%).
- Dexmedetomidine was associated with lower delirium risk (RR = 0.612, 95% CI: 0.471-0.796); esketamine and ketamine estimates were not statistically significant.
Why it matters
POD is associated with substantial morbidity and longer-term cognitive consequences. This synthesis suggests that anesthetic strategies limiting opioid use may reduce delirium risk, while also showing that results differ across agents. The findings add evidence for considering delirium outcomes when evaluating perioperative anesthetic regimens, but do not establish equal benefit for every opioid-sparing approach.
What to keep in mind
The pooled estimate had moderate heterogeneity (I2 = 52.2%), and subgroup estimates for esketamine and ketamine did not show statistically significant benefit.