Quality of recovery after laparoscopic cholecystectomy: a randomized trial of pneumoperitoneum pressure and neuromuscular blockade depth
Qualidade da recuperação após colecistectomia laparoscópica: um ensaio randomizado sobre pressão do pneumoperitônio e profundidade do bloqueio neuromuscular
José Fernando Amaral Meletti, Marina Gasparotto Fernandes, Eduardo Toshiyuki Moro, Evaldo Marchi
Abstract
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.
Keywords
Resumo
Introdução
A colecistectomia laparoscópica (LC) é um procedimento cirúrgico comumente realizado. O pneumoperitônio e a profundidade do bloqueio neuromuscular (NMB) podem impactar a ocorrência de dor pós-operatória e a qualidade da recuperação.
Métodos
Ensaio clínico randomizado, duplo-cego e prospectivo com 124 pacientes submetidos à LC, divididos em 4 grupos:
• PA/BNM (Standard Pneumoperitoneum pressure and Moderate NMB → Pressão de pneumoperitônio padrão e bloqueio neuromuscular moderado);
• PB/BNM (Low Pneumoperitoneum pressure and Moderate NMB → Pressão de pneumoperitônio baixa e bloqueio neuromuscular moderado);
• PA/BNP (Standard Pneumoperitoneum pressure and Deep NMB → Pressão de pneumoperitônio padrão e bloqueio neuromuscular profundo);
• PB/BNP (Low Pneumoperitoneum pressure and Deep NMB → Pressão de pneumoperitônio baixa e bloqueio neuromuscular profundo).
A qualidade da recuperação foi avaliada por meio do Quality of Recovery Questionnaire (QoR-40), e a dor pós-operatória foi medida por meio da Verbal Numerical Rating Scale (VNRS).
Resultados
Não houve diferença entre os grupos quanto à pontuação total do QoR-40 após 24 horas da cirurgia (p = 0,903). Apesar das melhores condições cirúrgicas (pontuação de 0 a 5) observadas no grupo PB/BNP (4,7 ± 0,52) e piores no grupo PB/BNM (4,1 ± 0,95), o grupo PB/BNP apresentou maior tempo de permanência na Sala de Recuperação Pós-Anestésica (SRPA), maior necessidade de tratamento de resgate para náuseas e vômitos na enfermaria (p = 0,044) e dor em repouso mais intensa após 24 horas (p = 0,027).
Conclusion
O uso de diferentes pressões de pneumoperitônio, sob bloqueio neuromuscular moderado ou profundo, em pacientes submetidos à colecistectomia laparoscópica (LC) não alterou a percepção dos pacientes sobre a qualidade da recuperação pós-operatória. A combinação de pressão de pneumoperitônio padrão com bloqueio neuromuscular profundo foi associada à melhor percepção da qualidade do campo cirúrgico, conforme avaliação do cirurgião.
Palavras-chave
References
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Submitted date:
04/07/2025
Accepted date:
07/18/2025
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