Advances in Opioid-Sparing Techniques for Ambulatory Surgery

Abstract

Ambulatory surgery has expanded rapidly, shifting the burden of postoperative pain management from monitored wards onto patients recovering at home, and this shift has intensified interest in reducing perioperative opioid exposure. This review synthesizes recent comparative evidence on opioid-sparing and opioid-free anesthetic strategies for ambulatory procedures, including multimodal non-opioid pharmacotherapy, dexmedetomidine-ketamine-lidocaine substitution regimens, and regional and local anesthetic techniques. Across procedure types ranging from laparoscopic and bariatric surgery to spine, thoracoscopic, and plastic surgery, opioid-sparing regimens consistently reduce perioperative and take-home opioid consumption, and regional anesthesia in particular contributes the most reliable additional analgesic benefit when layered onto systemic multimodal therapy. Gabapentinoids show a more inconsistent benefit-to-risk profile and are better reserved for selected patients than used routinely, while opioid-free general anesthesia protocols require hemodynamic management skills and infrastructure that remain unevenly distributed across ambulatory facilities. We conclude that the evidence now supports opioid minimization as a default orientation for ambulatory anesthetic practice, with implementation barriers, rather than remaining evidentiary gaps, as the principal obstacle to broader adoption.