It has been speculated that opioid-free anesthesia may provide adequate pain control while reducing postoperative opioid consumption; however, there is currently no evidence to support the speculation. In this issue of Anesthesiology, Beloeil et al. tested the hypothesis that opioid-free balanced anesthetic with dexmedetomidine would reduce postoperative opioid-related adverse events compared to balanced anesthesia with remifentanil. Also in this issue, Shanthanna et al. present a critical review of opioid-free versus opioid-sparing approaches. In an accompanying editorial, Kharasch and Clark review the evolution of opioid-free anesthesia and call for a balanced approach to use of opioids in moderation going forward. Cover Illustration: A. Johnson, Vivo Visuals.

  • Beloeil et al.: Balanced Opioid-free Anesthesia with Dexmedetomidine versus Balanced Anesthesia with Remifentanil for Major or Intermediate Noncardiac Surgery: The Postoperative and Opioid-free Anesthesia (POFA) Randomized Clinical Trial, p. 541

  • Shanthanna et al.: Perioperative Opioid Administration: A Critical Review of Opioid-free versus Opioid-sparing Approaches, p. 645

  • Kharasch and Clark: Opioid-free Anesthesia: Time to Regain Our Balance, p. 509