North American and European practices for opioid-sparing and opioid-free anaesthesia: a cross-sectional survey

Yann Gricourt; Nancy M Boulos; Yann Daoulas; Tristan Grogan; Brenton Alexander; Myriam Mezzarobba; Philippe Cuvillon; Esther M Pogatzki-Zahn; Helene Beloeil; Maxime Cannesson; Patrice Forget; Alexandre Joosten

doi:10.1016/j.bjao.2025.100511

North American and European practices for opioid-sparing and opioid-free anaesthesia: a cross-sectional survey

BJA Open. 2025 Dec 15:16:100511. doi: 10.1016/j.bjao.2025.100511. eCollection 2025 Dec.

Authors

Yann Gricourt^{1

2

3}, Nancy M Boulos², Yann Daoulas⁴, Tristan Grogan⁵, Brenton Alexander⁶, Myriam Mezzarobba⁷, Philippe Cuvillon^{1

3}, Esther M Pogatzki-Zahn⁸, Helene Beloeil⁹, Maxime Cannesson², Patrice Forget^{3

10

11

12}, Alexandre Joosten²

Affiliations

¹ Department of Anesthesiology and Perioperative Medicine, Nimes University Hospital, Nimes, France.
² Department of Anesthesiology & Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
³ IMAGINE UR UM 103, Montpellier University, Anaesthesia Critical Care, Emergency and Pain Medicine Division, Nîmes University Hospital, Nîmes, France.
⁴ Department of Anesthesiology and Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France.
⁵ Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
⁶ Department of Anesthesiology & Perioperative Medicine, University of California San Diego, La Jolla, CA, USA.
⁷ Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, IDESP, INSERM, University of Montpellier, Nimes, France.
⁸ Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.
⁹ University of Rennes, CHU Rennes, Inserm, OSS 12142, CIC 1414, Anaesthesia and Intensive Care Department, Rennes, France.
¹⁰ Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Aberdeen, UK.
¹¹ Anaesthesia Department, NHS Grampian, Aberdeen, UK.
¹² Pain and Opioids after Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care (ID ESAIC_RG_PAND) Research Group, Brussels, Belgium.

Abstract

Background: Opioids remain central to perioperative analgesia but concerns about the growing opioid crisis and adverse effects have prompted revaluation of their role. Opioid-sparing anaesthesia and opioid-free anaesthesia (OFA) have emerged as alternatives, yet their clinical adoption remains uncertain. This survey assessed adoption and perceptions among anaesthesiologists in North America and Europe.

Methods: A 26-question cross-sectional, web-based survey was distributed via email to members of the American, European, and French Societies of anaesthesiologists. The survey assessed routine use of opioid-sparing techniques, defined as the regular use of non-opioid analgesics and adjuncts to minimise intraoperative opioid use in the past month. We hypothesised that fewer than 50% of anaesthesiologists routinely used these techniques during this period.

Results: The overall response rate was 2% among ASA members (614/31 000) and 12% among European Society of Anaesthesiology and Intensive Care (ESAIC) members (414/3500). Concern about opioid use was reported as high in ESAIC and ASA members (90% vs 83%, P<0.001). Daily use of opioid sparing techniques was reported by 37% (95% confidence interval [CI] 32-42%) of ESAIC and 40% (95% CI 36-45%) of ASA members. OFA use was less common overall but reported to be higher by ASA repondents (21%, 95% CI 18-25%) vs 12% (95% CI 9-15%), P<0.001) for EASIC respondents. Perceived risks differed: EASIC respondents more often cited haemodynamic instability (43% vs 16%, P<0.001), whereas ASA respondents more often cited patient dissatisfaction (55% vs 30%) and uncontrolled pain (72% vs 53%, both P<0.001). Key barriers to OFA adoption included limited training, low confidence, and lack of evidence-based guidelines.

Conclusions: Interest in opioid-sparing anaesthesia and OFA is widespread, but routine use remains modest and varies by region. Regional perceptions, institutional protocols, and confidence in evidence appear to influence implementation.

Keywords: analgesia; dexmedetomidine; intraoperative management; ketamine; multimodal analgesia; opioid crisis; opioid-free anaesthesia; regional anaesthesia.

Grants and funding

T32 GM148369/GM/NIGMS NIH HHS/United States