Impact of low-pressure pneumoperitoneum and deep neuromuscular blockade on surgeon satisfaction and patient outcomes in laparoscopic cholecystectomy patients: A prospective randomised controlled study

• Published in: Journal of minimal access surgery 2024-10
• Main Authors: Koç, Alparslan, Memiş, Ufuk, Onk, Didem, Karataş, Talha, Gazi, Mustafa, Sayar, Ali Caner, Arı, Muhammet Ali
• Format: Article
• Language: English
• ISSN: 0972-9941; 1998-3921
• DOI: 10.4103/jmas.jmas_78_24

The impact of laparoscopic surgery on homeostatic systems necessitates careful consideration of intra-abdominal pressure (IAP) management. This study investigated the effects of low-pressure pneumoperitoneum with deep neuromuscular blockade (NMB) on surgeon satisfaction, haemodynamics and post-operative outcomes in laparoscopic cholecystectomy patients. The study design involves prospective randomised control. Ninety patients were assigned to low (7-10 mmHg, n = 45) or normal (12-16 mmHg, n = 45) IAP groups. Deep NMB, guided by train-of-four monitoring, was administered. This study evaluated surgical rating scale scores, haemodynamics and post-operative outcomes through a literature review. A computer programme (IBM, SPSS) was used for statistical analysis. Chi-square and Mann-Whitney U tests were used to analyse patients' IAP levels, additional NMB requirements, surgical rating scale scores and numerical rating scales. Patient demographics and other intraoperative and post-operative variables were analysed with Student's t-test and the Mann-Whitney U test. Values of P < 0.05 were considered to indicate statistical significance. No significant demographic differences were observed. The low-pressure group exhibited lower post-operative pain (P < 0.01) and reduced analgesia requirements (P = 0.00). On analysis of the surgeon rating scale, no disparities were evident between the groups. NMB usage correlated with height and weight (P < 0.01). Heart rate showed no intergroup differences. The MAP measured after 15 min was lower in Group L, and the difference was significant (P = 0.023). The SAP measured after 30 min was lower in Group L, and the difference was significant (P = 0.017). Blood gas values and surgical field visibility were unaffected by the IAP. The positive correlations between NMB, height and weight aligned with previous research. This study highlights successful laparoscopic cholecystectomy under low IAP, deep NMB and favourable post-operative outcomes. Despite these limitations, the findings contribute to optimising laparoscopic surgical approaches.