 Is opioid-free anesthesia a better alternative for patients? The approach is increasingly discussed. It might reduce opioid-related side effects and the need for opioids post-op. But little is known about how it truly compares with opioid anesthesia. A randomized control trial published in anesthesiology has found that opioid-free anesthesia may not always be a good idea. Surgical patients going opioid-free had more serious adverse events than those using the drugs. Using five instances of severe bradycardia, which prematurely stopped the study. The post-operative and opioid-free anesthesia trial was conducted in more than 300 patients undergoing major or intermediate non-cardiac surgery at 10 medical centers in France. All patients received standard anesthesia induction. Then half were given the opioid remifentinal, plus morphine, while the other half received dexmedetomidine. The primary outcome was a composite of post-operative opioid-related adverse events, including hypoxemia, ileus, and cognitive dysfunction within the first 48 hours after extubation. Secondary outcomes included post-op pain, opioid consumption, and post-op nausea and vomiting. Before the trial was complete, five cases of severe bradycardia occurred, including three associated with acystole in the opioid-free group. While none of these instances led to permanent injury or complications, the Independent Data and Safety Monitoring Board decided to stop the trial early. Based on the data accumulated to that point, more patients in the opioid-free group experienced adverse events. The primary composite outcome, for example, occurred in 78% of dexmedetomidine patients compared to 67% of patients in the opioid group. This was driven by an increase in post-op hypoxemia in the opioid-free group, as there was no difference in ileus or cognitive dysfunction. The opioid-free group did consume less morphine after surgery and had less post-op nausea and vomiting. But those patients also had delayed extubation and longer stays in the post-anesthesia care unit. Rather than producing fewer adverse events, opioid-free anesthesia resulted in more of these serious events, especially hypoxemia and bradycardia. The authors suspect that the higher rate of serious events may be due to the relatively high dose of dexmedetomidine used, which was based on a patient's heart rate. It could also be due to the other drugs used, including lidocaine and ketamine. The findings suggest that least when using the drug combination assessed in this study, opioids may be the better option.