Quality of recovery after laparoscopic cholecystectomy: a randomized trial of pneumoperitoneum pressure and neuromuscular blockade depth

Introduction

Laparoscopic Cholecystectomy (LC) is a commonly performed surgical procedure. The pneumoperitoneum and the depth of Neuromuscular Blockade (NMB) may impact the occurrence of postoperative pain and the quality of recovery.

Methods

A randomized, double-blind, and prospective clinical trial with 124 patients undergoing LC, divided into 4 groups: SP/MB (Standard Pneumoperitoneum pressure and Moderate NMB); LP/MB (Low Pneumoperitoneum pressure and Moderate NMB); SP/DB (Standard Pneumoperitoneum pressure and Deep NMB); and LP/DB (Low Pneumoperitoneum pressure and Deep NMB). Recovery quality was assessed using the Quality of Recovery Questionnaire (QoR-40), and postoperative pain was evaluated using a Verbal Numerical Rating Scale (VNRS).

Results

No difference was observed between groups regarding the total QoR-40 score 24 hours after surgery (p = 0.903). Despite better surgical conditions (scored from 0 to 5) in the LP/DB group (4.7 ± 0.52) and lower in the LP/MB group (4.1 ± 0.95), the LP/DB group showed a longer stay in the Post-Anesthesia Care Unit (PACU), a higher need for rescue treatment for nausea and vomiting in the ward (p = 0.044), and greater resting pain at 24 hours (p = 0.027).

Conclusion

The use of different pneumoperitoneum pressures under moderate or deep neuromuscular blockade in patients undergoing Laparoscopic Cholecystectomy (LC) did not alter patients’ perception of postoperative recovery quality. The combination of standard pneumoperitoneum pressure with deep neuromuscular blockade was associated with a better perception of surgical field quality as evaluated by the surgeon.