Meletti José Fernando Amaral, Fernandes Marina Gasparotto, Moro Eduardo Toshiyuki, Marchi Evaldo
Faculdade de Medicina de Jundiaí, Departamento de Cirurgia, Jundiaí, SP, Brazil.
Faculdade de Medicina de Jundiaí, Pós-Graduação em Ciências da Saúde, Jundiaí, SP, Brazil.
Braz J Anesthesiol. 2025 Jul 29;75(6):844667. doi: 10.1016/j.bjane.2025.844667.
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.
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).
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).
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.
腹腔镜胆囊切除术（LC）是一种常见的外科手术。气腹和神经肌肉阻滞（NMB）的深度可能会影响术后疼痛的发生和恢复质量。
一项随机、双盲、前瞻性临床试验，124例接受LC的患者被分为4组：SP/MB（标准气腹压力和中度NMB）；LP/MB（低气腹压力和中度NMB）；SP/DB（标准气腹压力和深度NMB）；LP/DB（低气腹压力和深度NMB）。使用恢复质量问卷（QoR-40）评估恢复质量，使用言语数字评定量表（VNRS）评估术后疼痛。
术后24小时各组间QoR-40总分无差异（p = 0.903）。尽管LP/DB组的手术条件评分（0至5分）更好（4.7±0.52），LP/MB组更低（4.1±0.95），但LP/DB组在麻醉后恢复室（PACU）停留时间更长，在病房中恶心呕吐的抢救治疗需求更高（p = 0.044），且24小时静息痛更严重（p = 0.027）。
在接受腹腔镜胆囊切除术（LC）的患者中，在中度或深度神经肌肉阻滞下使用不同的气腹压力并未改变患者对术后恢复质量的感知。标准气腹压力与深度神经肌肉阻滞相结合，经外科医生评估，与对手术视野质量的更好感知相关。
