1. To evaluate the efficacy of a standardized multimodal Opioid Sparing (OS) protocol versus conventional opioid-based analgesia in reducing acute postoperative 2. To quantify opioid consumption reduction achievable through OS strategies 3. To assess the impact of OS on hemodynamic parameters during critical surgical phases 4. To compare recovery metrics (PONV, bowel function, ambulation) 5. To evaluate the safety profile of OS anesthesia
Adults aged 18 to 60 years scheduled for elective laparoscopic cholecystectomy. Elective must be included in title.
ASA (American Society of Anesthesiologists) physical status I or II.
Body Mass Index (BMI) < 35 kg/m².
Chronic opioid use (>30 MME/day for >3 months).
Contraindications to study medications (e.g., severe hepatic impairment; allergy/contraindication to lidocaine, dexmedetomidine, ketamine, fentanyl, or NSAIDs).
Renal dysfunction (eGFR <60 mL/min/1.73 m²).
Significant cardiac conduction abnormalities.
Parallel
opoid free anesthesia
Other interventionMaintenance Dexmedetomidine 0.2-0.5 µg/kg/h + Lidocaine 1.5 mg/kg/h + Magnesium 10 mg/kg/h; Sevoflurane as required; Atracurium 0.1 mg/kg IV PRN
Pain intensity at rest postoperatively (Visual Analog Scale, VAS, 0-10)
Pain intensity at rest will be measured using the Visual Analog Scale (VAS), which ranges from 0 (no pain) to 10 (worst imaginable pain). Higher scores indicate worse pain.
Cumulative opioid use (MME)
Cumulative opioid consumption will be measured in morphine milligram equivalents (MME) administered to each patient.
Time to extubating
Time to extubating; time to Aldrete ≥9
Time to first rescue analgesia
time to first demand for rescue analgesia
Bowel recovery (first flatus)
Time in hours from completion of surgery until the patient passes first flatus, representing bowel recovery.
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