Beloeil H, Garot M, Lebuffe G, et al. - Whether opioid-free balanced anesthetic with dexmedetomidine decreases postoperative opioid-associated adverse events relative to balanced anesthetic with remifentanil, was investigated in this study. Participants were randomly assigned to receive a standard balanced anesthetic with either intraoperative remifentanil plus morphine (remifentanil group) or dexmedetomidine (opioid-free group). Intraoperative propofol, desflurane, dexamethasone, lidocaine infusion, ketamine infusion, neuromuscular blockade, and postoperative lidocaine infusion, paracetamol, nefopam, and patient-controlled morphine were administered to all patients. A composite of postoperative opioid-associated adverse events (hypoxemia, ileus, or cognitive dysfunction), observed within the first 48 h post-extubation, was the primary outcome. Findings refuted the hypothesis that fewer postoperative opioid-associated adverse events would be offered by balanced opioid-free anesthesia with dexmedetomidine vs remifentanil. Rather it provided a greater incidence of serious adverse events, particularly hypoxemia and bradycardia.