Abstract: Objective To investigate the effects of opioid-free anesthesia (OFA) on the incidence of postoperative nausea and vomiting (PONV) and the quality of recovery in patients undergoing laparoscopic cholecystectomy.Methods A prospective,randomized,double-blind,single-center clinical trial was conducted.A total of 96 patients scheduled for elective laparoscopic cholecystectomy between May 2025 and November 2025 were randomly allocated to either the opioid-free anesthesia (OFA) group (nP=48) or the opioid-based anesthesia (OBA) group (nP=48).The primary outcomes were the incidence of PONV and Rhodes Index of Nausea and Vomiting scores at 6 and 24 hours postoperatively.Secondary outcomes included the Quality of Recovery-15 (QoR-15) score,Visual Analogue Scale (VAS) for pain,analgesic consumption,and patient satisfaction.Results The incidence of PONV within 24 hours postoperatively was 8.3% in the OFA group and 22.9% in the OBA group,and the incidence of nausea was 10.4% and 39.6%,respectively;the differences between the two groups were statistically significant (P<0.05).The Rhodes Index of Nausea and Vomiting scores at 6 hours postoperatively were (0.5±1.1) in the OFA group and (1.5±1.7) in the OBA group,and at 24 hours postoperatively were (0.2±0.5) and (0.9±1.3),respectively (P<0.05).The QoR-15 scores at 6 hours postoperatively were (145.4±2.6) in the OFA group and (138.7±7.7) in the OBA group,and at 24 hours postoperatively were (148.2±1.1) and (144.8±5.4),respectively (P<0.05).The VAS scores at 6 hours postoperatively were (1.2±1.4) in the OFA group and (1.9±1.2) in the OBA group,and at 12 hours postoperatively were (0.3±0.7) and (0.9±0.9),respectively (P<0.05).The number of rescue analgesia administrations in the OFA group and OBA group were (0.29±0.6) and (0.63±1.0),respectively,and patient satisfaction scores were (9.8±0.5) and (9.4±0.8),respectively (P<0.05).The awakening time,extubation time,and time to meet post-anesthesia care unit discharge criteria in the OFA group and OBA group were (13.9±4.3) min and (9.5±3.9) min,(2.4±1.8) min and (1.6±0.6) min,(24.5±5.0) min and (7.8±2.5) min,respectively (P<0.05).Conclusion The OFA regimen based on dexmedetomidine and esketamine significantly reduces the incidence and severity of PONV,provides effective analgesia,reduces opioid requirements,improves patient satisfaction,and does not increase serious adverse reactions in patients undergoing laparoscopic cholecystectomy.Although the time to awakening,extubation,and early postoperative recovery in the OFA group was slightly prolonged compared with the OBA group,the magnitude of the differences was small and remained within the clinically acceptable range.

Key words: opioid-free anesthesia; postoperative nausea and vomiting; laparoscopic cholecystectomy; enhanced recovery after surgery; multimodal analgesia