Impact of Opioid‐Free Anesthesia Combined With Enhanced Recovery After Surgery Protocol on Postoperative Recovery Quality in Patients Undergoing Laparoscopic Total Hysterectomy

Aim Opioid‐based anesthesia in laparoscopic hysterectomy is associated with adverse effects (e.g., postoperative nausea and vomiting [PONV], ileus, cognitive impairment) that impede recovery. This study evaluates whether opioid‐free anesthesia (OFA) combined with an Enhanced Recovery After Surgery (ERAS) protocol improves postoperative recovery quality. Methods This retrospective cohort study included 255 patients who underwent laparoscopic total hysterectomy between February 2023 and April 2025. Patients were allocated to TOA (124 patients received traditional opioid‐based anesthesia) and OFA + ERAS (131 patients received OFA combined with ERAS) groups. Outcomes included recovery times, hemodynamic stability, pain scores (Visual Analog Scale [VAS]), cognitive function (Mini‐Mental State Examination [MMSE]), adverse events, sleep quality, and quality of life (QOR‐15, Activities of Daily Living [ADL]). Multivariate analyses were performed to adjust for potential confounders. Results The OFA + ERAS group demonstrated significantly shorter time to awakening ( p < 0.001), extubation ( p < 0.001), first flatus ( p < 0.001), and hospital stay ( p < 0.001). Postoperative pain scores were consistently lower in the OFA + ERAS group at all time points (all p < 0.001), with a 72% reduction in the odds of tramadol use (OR = 0.28, 95% CI: 0.14–0.56, p < 0.001). The incidence of PONV (OR = 0.35, p = 0.002) and postoperative cognitive dysfunction (OR = 0.31, p = 0.008) was significantly reduced. The OFA + ERAS group also showed better hemodynamic stability during surgery and improved MMSE, sleep quality, QOR‐15, and ADL scores at 48 h postoperatively (all p < 0.001). Conclusion OFA combined with ERAS enhances postoperative recovery in laparoscopic total hysterectomy by reducing pain, opioid‐related complications, and hospital stay while improving cognitive and functional outcomes.