1408 Bali Medical Journal 2021; 10(3) Special Issue ICONURS: 1408-1414 | doi: 10.15562/bmj.v10i3.2984 REVIEW ABSTRACT Impact of Opioid-Free Anesthesia on Nausea, Vomiting and pain Treatment in Perioperative Period: A Review Made Suandika 1* , Refa Teja Muti 1 , Woung Ru-Tang 2 , Siti Haniyah 3 , Dwi Astuti 4 The use of opioids as anti-pain medications in the perioperative period is infuenced by intraoperative anaesthesia. There is no conclusive evidence that intraoperative opioids decrease postoperative pain. Opioid-free anaesthesia, which combines several opioid-sparing approaches, has lowered the need for postoperative pain control by reducing the need for restricted pain relief. As a result, the goal of this study is to determine the scope of the benefts of going opioid-free throughout the perioperative period. The electronic databases Google Scholar, Science Direct, and PubMed were searched till May 2021. Analytical reviews, randomized controlled trials, and prospective studies comparing all types of intra-operative opioid general anaesthesia against opioid-free general anaesthesia were included in the study. The frst measurement of the pain score at rest and one day after surgery were the key goals. Analgesia was defned as the consumption of comparable intravenous morphine after surgery, as well as rates of postoperative nausea and vomiting in the post-anaesthesia care unit one day after surgery. The opioid-free anaesthesia group had lower mean pain scores at rest at the frst measurement and postoperatively than the opioid-free anaesthesia group. In the opioid group, postoperative analgesia intake of iv morphine was lower. There was a statistically signifcant decrease in nausea and antiemetic medicine use among patients who did not get opioids. The opioid-free group had a longer hospital stay. Opioid-free use did not demonstrate signifcant results in lowering pain in the postoperative period when compared to those who used opioids. It’s also linked to less nausea and vomiting after surgery. Keywords: Nausea and vomiting treatment, Opioid-free anesthesia, General anesthesia, Perioperative phase, Pain. Cite This Article: Suandika, M., Muti, R.T., Ru-Tang, W., Haniyah, W., Astuti, D. 2021. Impact of Opioid-Free Anesthesia on Nausea, Vomiting and pain Treatment in Perioperative Period: A Review. Bali Medical Journal 10(3) Special Issue ICONURS: 1408-1414. DOI: 10.15562/bmj.v10i3.2984 1 Anesthesiology Department of Faculty of Health Science Harapan Bangsa University Purwokerto, Central Java Indonesia, 2 Professor School of Nursing College of Medicine Chang Gung University, Taiwan 3 School of Nursing of Faculty of Health Science Harapan Bangsa University Purwokerto, Central Java Indonesia 4 School of Nursing Politeknik Yakpermas Banyumas, Central Java Indonesia *Corresponding to : School of Nursing Faculty of Health Science Harapan Bangsa University, Purwokerto, Central Java Indonesia, Telp : 082146935020 ; madesuandika@uhb.ac.id, https://orcid.org/0000-0001-9966-4066 Received: 2021-11-22 Accepted: 2021-12-25 Published:2021-12-30 Bali Medical Journal (Bali MedJ) 2021, Volume 10, Number 3 Special Issue ICONURS: 1408-1414 P-ISSN.2089-1180, E-ISSN: 2302-2914 Open access: www.balimedicaljournal.org INTRODUCTION General anesthesia is a procedure negates pleasure centrally for the satisfaction of conscious consciousness can be recovered (reversible). General anesthesia causes numbness because this drug enters the brain tissue with local high pressure. General anesthesia is also known as narcotics or anesthesia. 1–5 Te aims of general anesthesia were to relieve pain, render unconsciousness, and cause amnesia that is reversible and predictable. Tree pillars of general anesthesia include hypnotics or sedatives, which make patient or rest/calm, analgesia or no feeling pain, muscle relaxation, i.e. skeletal muscle paralysis, and accuracy autonomic nerves between the sympathetic and parasympathetic nerves. 6,7 One of the general anesthetic techniques is done by injecting parenteral anesthetic drugs directly into the veins. Intravenous anesthetic drugs include opioid narcotics, namely ketamine HCl, thiopentone, propofol, diazepam, deidrobenzperidol, midazolam, pethidine, morphine, fentanyl/sufentanyl which can have an impact on complications. Although the administration of opioid drugs can ideally recover gradually and without complaints, monitoring of post- general anesthesia complications must be considered comprehensively in the form of respiratory disorders, namely partial or total airway obstruction, no expiration (no breath sounds) most ofen experienced in post-general anesthesia patients who are unconscious because the tongue falls to cover the pharynx or laryngeal edema. Another cause is laryngeal spasm (laryngeal spasm) in patients who are near conscious because the larynx is stimulated by foreign objects, blood or secretions. In addition, administering anesthesia with a combination of opioid drugs, the client may experience cyanosis (hypercapnia, hypercarbia) or decreased O2 saturation (hypoxemia) due to the patient’s slow and shallow breathing (hypoventilation). Slowed breathing can be caused by the infuence of opioid drugs due to muscle relaxants that are still working, tolerance and hyperalgesia which can develop into chronic pain syndrome. 8,9 Pain that is acute and progresses to chronic has the potential to occur during and afer surgical procedures. Chronic pain that is not treated adequately can cause a number of physiological and psychological disorders afer anesthesia. Post-anesthesia nausea and vomiting (PONV) can occur in 80% of patients undergoing surgery and anesthesia. In addition, some patients prefer to feel pain than post-anesthesia nausea and vomiting .9–12 Post-anesthesia PONV is a common side efect following opioid sedation and anesthesia. Te incidence is highest with narcotic-based anesthetics and with volatile agents. 9,11,13 Every three to four patients develop postoperative PONV afer general anesthesia. 4–7,9–11,14,15 Te risk of postoperative PONV is 9 times less in patients under regional anesthesia than in patients under general anesthesia. 16–18