少阿片麻醉对术后恢复质量及阿片相关不良反应的影响：系统综述

Effects of Opioid-Sparing Anesthesia on Postoperative Quality of Recovery and Opioid-Related Adverse Effects: A Systematic Review

Abstract: Objective: To systematically summarize the effects of opioid-sparing or opioid-free anesthesia (OSA/OFA) on postoperative quality of recovery and opioid-related adverse effects, with emphasis on gynecological and gynecologic oncology surgery. Methods: PubMed, Embase, the Cochrane Library, and Web of Science were searched, and reference lists were screened. Randomized trials, cohort studies, and systematic reviews comparing OSA/OFA with opioid-based anesthesia were considered. Primary outcomes were quality of recovery, pain, and opioid consumption; secondary outcomes included nausea and vomiting, respiratory depression, sedation, delirium, bowel recovery, length of stay, and readmission. Because interventions and outcome definitions were heterogeneous, a narrative synthesis was performed. Results: Current evidence suggests that OSA/OFA can reduce postoperative opioid exposure without compromising early analgesia and may improve 24-hour recovery while reducing nausea, vomiting, pruritus, and excessive sedation. However, regimens based on dexmedetomidine, ketamine, lidocaine, and regional blocks have specific risks, including hypotension, bradycardia, delayed emergence, and psychotomimetic symptoms. Trials in gynecological laparoscopy and hysterectomy show favorable trends in recovery scores, early mobilization, and discharge readiness, while observational data in open gynecologic oncology surgery support better patient-reported outcomes with opioid-sparing pathways. Conclusions: OSA/OFA should be implemented as a multimodal ERAS pathway rather than as replacement by a single drug. In gynecologic oncology, regional analgesia, acetaminophen/non-steroidal anti-inflammatory drugs, low-dose ketamine or dexmedetomidine, intravenous lidocaine, and local infiltration can form the basis of care, with rescue opioids retained according to risk and joint respiratory, circulatory, pain, and functional outcomes used for evaluation.