Abstract:Objective To explore the application effect of opioid-free general anesthesia in laparoscopic cholecystectomy and its impact on postoperative recovery quality in patients. Methods This was a prospective parallel randomized controlled trial. A total of 74 patients undergoing elective laparoscopic cholecystectomy at the First People's Hospital of Lianyungang from October 2022 to August 2023 were enrolled. They were divided into two groups using a random number table: the opioid group (OA group, n=37) and the opioid-free group (OFA group, n=37). The primary outcome was the 15-item Quality of Recovery Score (QoR-15) on postoperative day 1 and day 2. Secondary outcomes included opioid-related adverse reactions on postoperative day 1, mean arterial pressure (MAP), and bispectral index (BIS) values at six time points: upon entering the operating room (T0), at the start of induction in OA group (T1) or 10 min after dexmedetomidine induction in OFA group (T1), after tracheal intubation (T2), before surgery (T3), after skin incision (T4), and after extubation (T5). Results The QoR-15 scores of the OFA group were significantly higher than those of the OA group on postoperative day 1 [110.0 (105.5, 112.0) vs 79.0 (76.5, 80.5), Z=7.414, P< 0.01]and day 2 [128.0 (127.0, 131.0) vs 94.0 (91.0, 97.0), Z=7.419, P<0.01]. Compared with OA group, OFA group had lower incidence rate of adverse reactions such as headache [18.92% (7/37) vs 0, χ²=5.680,P=0.017], fatigue [21.62% (8/37) vs 2.7% (1/37), χ²=4.554,P=0.033], and dry mouth [16.22% (6/37) vs 0, χ²=4.534,P= 0.033]. There were statistically significant differences in MAP between the two groups at T1 and T3 (P<0.01). Conclusion The application of opioid - free general anesthesia in laparoscopic cholecystectomy can significantly improve patient's postoperative recovery quality, reduce the incidence of postoperative adverse reaction such as headache, fatigue and dry mouth, and maintain more stable perioperative MAP.