Effect of Opioid-sparing Anesthesia on Quality of Recovery After Emergency Laparotomy

Opioids are widely used during anesthesia for pain control, but they cause many side effects-such as nausea, constipation, respiratory depression, dependence, and delayed recovery. They can also worsen low blood pressure in patients with unstable circulation. Because of these risks, multimodal analgesia is recommended to reduce opioid use. Research on other non-opioid options is limited. Systemic lidocaine offers anti-inflammatory and opioid-sparing benefits and improves recovery in elective colorectal surgery, but its role in emergency laparotomy is still unclear and requires further study.

Inclusion Criteria: * Adult patients (21-65 years), ASA I-III undergoing emergency laparotomy with midline incision Exclusion Criteria: * Severe cardiac morbidities (impaired contractility with ejection fraction \< 45%, heart block, arrhythmias, tight valvular lesions) * Patients on vasopressor infusion, patients with high shock index (heart rate / systolic blood pressure \>1) * Body mass index \ 35 Kg/m2, * Pregnant or lactating women, * Allergy of any of the study drugs * Severe liver cell failure and renal impairment by history and/or abnormal liver and kidney function tests.