Quality of Recovery After Laparoscopic Ovarian Cystectomy: A Randomized Controlled Trial Comparing Opioid-Free Multimodal Analgesia Versus Opioid-Based Anesthesia.

Background: Opioid-based anesthesia, though effective for pain control, is often associated with side effects such as nausea, vomiting, and delayed recovery. In the context of minimally invasive procedures like laparoscopic ovarian cystectomy, there is increasing interest in opioid-free anesthesia (OFA) to enhance postoperative outcomes. Objective: To compare the quality of recovery between opioid-free and opioid-based anesthesia using the QoR-15 score in patients undergoing laparoscopic ovarian cystectomy. Methods: This double-blind, randomized controlled trial included 80 ASA I-II female patients aged 18-65 undergoing elective laparoscopic ovarian cystectomy. Participants were randomized equally to receive either opioid-free multimodal anesthesia (dexmedetomidine, lidocaine, ketamine, paracetamol) or conventional opioid-based anesthesia. The primary outcome was QoR-15 score at 24 hours. Secondary outcomes included intraoperative anesthetic requirements, hemodynamic stability, postoperative pain, and adverse events. Results: Patients in the OFA group had significantly higher QoR-15 total scores (192 vs. 173; p = 0.029), especially in physical comfort (p = 0.014), independence (p = 0.035), and pain domains (p = 0.021). The OFA group also required a lower propofol maintenance dose (5.64 ± 1.21 vs. 6.32 ± 1.81 mg/kg/h; p = 0.012), had a longer time to first analgesic request (42.6 ± 7.52 vs. 33.6 ± 7.17 min; p = 0.003), and experienced fewer adverse effects such as nausea (15% vs. 45%; p < 0.001) and vomiting (10% vs. 30%; p < 0.001). Conclusions: Opioid-free multimodal anesthesia offers superior recovery quality, effective pain control, and fewer side effects compared to traditional opioid-based anesthesia in laparoscopic ovarian cystectomy. It is a viable alternative in enhanced recovery protocols.