Abstract:Objective To compare the influences of different opioid-associated anesthesia regimens on postoperative pain and perioperative hemodynamics in patients undergoing laparoscopic cholecystectomy. Methods A total of 117 patients who underwent laparoscopic cholecystectomy at the Dongcheng Branch of the First Affiliated Hospital of Anhui Medical University from February to September 2025 were randomly selected，and divided into three groups according to the random number table method：opioid-free anesthesia（OFA）group，opioid-sparing anesthesia（OSA）group and opioid - based anesthesia（OBA）group（39 cases each）. Mean arterial pressure（MAP）and heart rate（HR）were recorded at the time of entering the operating room（T0），after anesthesia induction（T1），1 min after laryngeal mask intubation（T2）and 1 min after pneumoperitoneum establishment（T3）. Blood pressure variability（BPV），coefficient of variation（CV）and average real variability（ARV）were calculated from MAP data. Visual Analogue Scale（VAS）was used to evaluate the degree of pain at 30 min，1 h，2 h and 6 h after returning to the ward. The PACU stay，rescue analgesics required within 24 h after surgery，the time to first flatus，and the occurrence of postoperative nausea and vomiting（PONV）were recorded. Results One case withdrew from the OFA group and one from the OSA group, finally 38，38 and 39 cases in OFA group, OSA group, and OBA group were included in the study. Patients in the OBA group had significantly lower HR at T1-T3 compared with the OFA group（P<0.05），while patients in the OSA group had significantly lower HR at T2 compared with the OFA group（P<0.05）. MAP at T1-T3 in the OBA group was significantly lower than that in both the OFA and OSA groups（P<0.05）. The BPVMAP，CVMAP，and ARVMAP all followed the order OBA group>OFA group>OSA group，with statistically significant differences（P<0.05）. The VAS scores of patients in the OBA group were significantly higher than those of patients in the OFA group and OSA group at 1 h，2 h，and 6 h after returning to the ward（P<0.05）. The rescue analgesia rates for patients in the OSA group，OFA group，and OBA group were 23.7%，31.6% and 53.8%，respectively，with statistically significant differences among the three groups（χ²=8.151，P=0.017）. The time to first flatus in patients gradually increased in the order of the OFA group，OSA group，and OBA group，with the difference being statistically significant （P<0.05）. Conclusion OSA can not only provide effective postoperative pain relief in patients undergoing laparoscopic cholecystectomy，but also maintain intraoperative hemodynamic stability without significantly delaying postoperative gastrointestinal recovery.