Historical version notice
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.
The current educational overview supersedes the earlier manuscripts and figures in this repository's Git history.
A visual review on 27 October 2026 covered all 37 pages of the image-based historical NOA PDF. It showed old institutional/clinical-observation framing, unsupported duplicate-reviewer and screening/appraisal claims, broad efficacy percentages and prescriptive medicine tables. These are not retained as verified evidence in the current source. No patient identifiers were apparent in this visual pass; that is not an exhaustive privacy or rights determination.
Do not use the earlier PDFs or figures as a clinical protocol or cite their unsupported findings as established results. The present overview is based on its named selected literature, not a report of authorized patient observations or institutional research. The older cover and acknowledgments do not establish institutional authorship, endorsement or permission.
Git history is preserved for provenance; it has not been rewritten. External deposits and distributed copies must be reconciled separately before any broader publication claim.
Withdrawn figures
The four files named Figure 1_ … to Figure 4_ … now contain only retirement notices. The original figures (TikZ sources with colon filenames, removed in commit 09aa4fb) remain in Git history and in older external copies. All four are withdrawn, including the implied search/selection flowchart (Figure 2), which had no supporting screening records.
Withdrawn Figure 3, "Representative Opioid Reduction Percentages Across Surgical Specialties". This bar chart showed "opioid reduction (%)" values of roughly 60–75% labelled by specialty and first author (Beloeil, Jin, Bakan, D'Amico, McCullough). The chart gave no source data, outcome definitions, denominators, comparators or confidence intervals, and the percentages could not be traced to the cited studies. They are unsourced and must not be cited or reused.
The chart also mislabelled the POFA trial (Beloeil H et al., Anesthesiology 2021;134(4):541-551, doi:10.1097/ALN.0000000000003725) as "Orthopedic" with a 70% reduction. POFA was a randomized trial in major or intermediate noncardiac surgery. Its primary composite outcome (postoperative hypoxemia, ileus or cognitive dysfunction) was more frequent with the dexmedetomidine opioid-free regimen (78% vs 67%), and the trial was stopped early after five cases of severe bradycardia. Lower postoperative opioid use was a secondary finding, not the trial's main result. Presenting POFA as evidence for a large, beneficial opioid reduction was wrong.
The current record (MANUSCRIPT.md, its PDF and the supersession record on Zenodo) supersedes this chart and every other historical figure, efficacy percentage and method claim. Where an older copy disagrees with the current record, the current record governs.
Verified external copy
The original concept DOI 10.5281/zenodo.17537969 resolved on 27 October 2026 to v10, record 17973755. Its 341,893-byte file has MD5 eda8ba3a6559a64285e1a5860f132abd, matching historical Git blob 8efb57e5da0149085eae913219014510fb953085. That v10 record (including the withdrawn Figure 3 content described above) still displays superseded efficacy claims; this repository cannot edit it. Do not cite the concept DOI or record 17973755 for this work. An author-approved correction and replacement files were published on 27 October 2026 as 2026.10-rc2, DOI 10.5281/zenodo.23705335. The old version remains separately identifiable.