# Non-opioid and opioid-sparing anesthesia: educational evidence overview

[Reader’s guide](START_HERE.md) · [Authorship & review status](AUTHORSHIP_AND_REVIEW.md) · [Disclaimer](DISCLAIMER.md) · [Portfolio home](https://collingeorge.github.io/CM-2026/)


## Applied clinical examples — 28 October 2026

- [Topic-specific paired cases](APPLIED_CASES.md): 5 male/female pairs (10 synthetic profiles), with worked applications, options and source maps.
- [Shared anesthesia options and cases](ANESTHESIA_OPTIONS_AND_CASES.md): the same four-modality guide and 12 general teaching cases used throughout the clinical portfolio.
- [Example format and verification standard](CASE_EXAMPLE_STANDARD.md), [topic source audit](EXAMPLE_SOURCE_AUDIT.json), and [shared source audit](SHARED_SOURCE_AUDIT.json).

These additions use a consistent educational format and source documentation; they do not certify clinical correctness, guideline compliance or patient-care suitability. The current rc2 manuscript/PDF content is not changed by this case supplement.


> **Educational work by a pre-medical student — not medical advice.** Not a clinical protocol, prescription, or patient handout, and not for patient care. See [DISCLAIMER](DISCLAIMER.md).
This revision narrows the earlier manuscript to a transparent discussion of selected published evidence. It does not claim a completed systematic review, independent duplicate screening, an original meta-analysis, a SANRA quality score, or verified search-flow counts.

The earlier source asserted two independent reviewers, agreement statistics, approximately 1,200 records and 45–50 included studies, formal risk-of-bias assessments, and inconsistent SANRA scores. Supporting screening and appraisal records were not supplied for this review. Those assertions are not retained in the revised source. No replacement reviewer history, search count, or study result has been invented.

## Current source

- [main.tex](main.tex): revised educational evidence overview.
- [supplementary.tex](supplementary.tex): provenance and evidence-audit requirements.
- bibliography.bib: companion BibTeX copy of the three references. It is **not** read by main.tex (which keeps an inline reference list) and the PDF is exported from MANUSCRIPT.md, so MANUSCRIPT.md is the reference list of record. Historical figures are retired.

The manuscript and supplementary PDFs are rebuilt from [MANUSCRIPT.md](MANUSCRIPT.md) and [EVIDENCE_AUDIT.md](EVIDENCE_AUDIT.md). Historical PDF filenames are retained for link compatibility: the main PDF's filename (`Non_Opioid_Anesthesia_..._A_Narrative_Review.pdf`) is a **historical filename** that still carries the withdrawn title. The document inside it is the current educational overview, not a scholarly narrative review. Retired figure files now contain retirement notices, not verified results. Any earlier DOI identifies its deposited version, not automatic validation or publication of this revision.

## Evidence boundaries

Opioid-free intraoperative anesthesia, opioid-sparing multimodal analgesia, and an entirely opioid-free recovery are distinct. Reduced opioid exposure does not establish better pain control, fewer complications, or improved long-term outcomes. The review must distinguish procedures, background analgesia, comparators, rescue options, and adverse-event ascertainment.

[POFA randomized trial](https://doi.org/10.1097/ALN.0000000000003725) (doi:10.1097/ALN.0000000000003725); [IV lidocaine consensus](https://doi.org/10.1111/anae.15270) (doi:10.1111/anae.15270); [gabapentinoid meta-analysis](https://doi.org/10.1097/ALN.0000000000003428) (doi:10.1097/ALN.0000000000003428; PMID 32667154).

Author: Collin B. George, pre-medical student. Independent educational portfolio; no institutional affiliation or endorsement is asserted for this work.

The prior README states CC BY 4.0. This revision preserves that stated license for the author's original material. It does not license third-party content or determine the rights status of legacy figures.

See [PUBLICATION_REVIEW.md](PUBLICATION_REVIEW.md) before release.

## Published correction

The author-approved [corrected educational overview and supersession notice](https://zenodo.org/records/23705335) was published on 27 October 2026, version 2026.10-rc2, DOI 10.5281/zenodo.23705335. It withdraws unsupported historical review-method, generalized efficacy and dosing claims. Earlier versions remain part of the record; the correction does not establish clinical validation.