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.