Quality of Recovery After Low-Pressure Laparoscopic Donor Nephrectomy Facilitated by Deep Neuromuscular Blockade: A Randomized Controlled Study

Denise M D Özdemir-van Brunschot, Gert J Scheffer, Michel van der Jagt, Hans Langenhuijsen, Albert Dahan, Janneke E E A Mulder, Simone Willems, Luuk B Hilbrands, Rogier Donders, Cees J H M van Laarhoven, Frank A d'Ancona, Michiel C Warlé, Denise M D Özdemir-van Brunschot, Gert J Scheffer, Michel van der Jagt, Hans Langenhuijsen, Albert Dahan, Janneke E E A Mulder, Simone Willems, Luuk B Hilbrands, Rogier Donders, Cees J H M van Laarhoven, Frank A d'Ancona, Michiel C Warlé

Abstract

Background: The use of low intra-abdominal pressure (<10 mmHg) reduces postoperative pain scores after laparoscopic surgery.

Objective: To investigate whether low-pressure pneumoperitoneum with deep neuromuscular blockade improves the quality of recovery after laparoscopic donor nephrectomy (LDN).

Design, setting and participants: In a single-center randomized controlled trial, 64 live kidney donors were randomly assigned to 6 or 12 mmHg insufflation pressure. A deep neuromuscular block was used in both groups. Surgical conditions were rated by the five-point Leiden-surgical rating scale (L-SRS), ranging from 5 (optimal) to 1 (extremely poor) conditions. If the L-SRS was insufficient, the pressure was increased stepwise.

Main outcome measure: The primary outcome measure was the overall score on the quality of recovery-40 (QOR-40) questionnaire at postoperative day 1.

Results: The difference in the QOR-40 scores on day 1 between the low- and standard-pressure group was not significant (p = .06). Also the overall pain scores and analgesic consumption did not differ. Eight procedures (24%), initially started with low pressure, were converted to a standard pressure (≥10 mmHg). A L-SRS score of 5 was significantly more prevalent in the standard pressure as compared to the low-pressure group at 30 min after insufflation (p < .01).

Conclusions: Low-pressure pneumoperitoneum facilitated by deep neuromuscular blockade during LDN does not reduce postoperative pain scores nor improve the quality of recovery in the early postoperative phase. The question whether the use of deep neuromuscular blockade during laparoscopic surgery reduces postoperative pain scores independent of the intra-abdominal pressure should be pursued in future studies.

Trial registration: The trial was registered at clinicaltrial.gov before the start of the trial (NCT02146417).

Figures

Fig. 1
Fig. 1
Patient enrollment
Fig. 2
Fig. 2
SRS immediate and 30 min after insufflation

References

    1. Wilson CH, Sanni A, Rix DA, Soomro NA. Laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev. 2011;11:CD006124.
    1. Gurusamy KS, Samraj K, Davidson BR. Low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2009;2:CD006930.
    1. Ozdemir-van Brunschot DM, van Laarhoven CJ, Scheffer GJ, Pouwels S, Wever KE, Warlé MC. What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review. Surg Endosc. 2015;30:2049–2065. doi: 10.1007/s00464-015-4454-9.
    1. Warle MC, Berkers AW, Langenhuijsen JF, et al. Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors’ comfort. Clin Transplant. 2013;27(4):E478–E483. doi: 10.1111/ctr.12143.
    1. Angioli R, Terranova C, Plott F, et al. Influence of pneumoperitoneum pressure on surgical field during robotic and laparoscopic surgery: a comparative study. Arch Gynecol Obstet. 2015;291(4):865–868. doi: 10.1007/s00404-014-3494-z.
    1. Vijayaraghavan N, Sistla SC, Kundra P, et al. Comparison of standard-pressure and low-pressure pneumoperitoneum in laparoscopic cholecystectomy: a double blinded randomized controlled study. Surg Laparosc Endosc Percutan Tech. 2014;24(2):127–133. doi: 10.1097/SLE.0b013e3182937980.
    1. Madsen MV, Gatke MR, Sprinborg HH, Rosenberg J, Lund J, Istre O. Optimising abdominal space with deep neuromuscular blockade in gynaecologic laparoscopy—a randomised, blinded crossover study. Acta Anaesthesiol Scand. 2015;59(4):441–447. doi: 10.1111/aas.12493.
    1. Staehr-Rye AK, Rasmussen LS, Rosenberg J, et al. Surgical space conditions during low-pressure laparoscopic cholecystectomy with deep versus moderate neuromuscular blockade: a randomized clinical study. Anesth Analg. 2014;119(5):1084–1092. doi: 10.1213/ANE.0000000000000316.
    1. Dubois PE, Putz L, Jamart J, Marotta ML, Gourdin M, Donnez O. Deep neuromuscular block improves surgical conditions during laparoscopic hysterectomy: a randomised controlled trial. Eur J Anaesthesiol. 2014;31(8):430–436. doi: 10.1097/EJA.0000000000000094.
    1. Ozdemir-van Brunschot DM, Scheffer GJ, Dahan A, et al. Comparison of the effectiveness of low pressure pneumoperitoneum with profound muscle relaxation during laparoscopic donor nephrectomy to optimize the quality of recovery during the early post-operative phase: study protocol for a randomized controlled clinical trial. Trials. 2015;16(1):345. doi: 10.1186/s13063-015-0887-7.
    1. Martini CH, Boon M, Bevers RF, Aarts LP, Dahan A. Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block. Br J Anaesth. 2014;112(3):498–505. doi: 10.1093/bja/aet377.
    1. Yarlagadda SG, Coca SG, Garg AX, et al. Marked variation in the definition and diagnosis of delayed graft function: a systematic review. Nephrol Dial Transplant. 2008;23(9):2995–3003. doi: 10.1093/ndt/gfn158.
    1. Nel D, Vogel J, Muller E, Barday Z, Kahn D. Slow early graft function: a neglected entity after renal transplantation. Nephron Clin Pract. 2012;120(4):200–204.
    1. De Oliviera GS, Fitzgerald PC, Marcus RJ, Ahmad S, McCarthy RJ. A dose-ranging study of the effect of transversus abdominis block on postoperative quality of recovery and analgesia after outpatient laparoscopy. Anesth Analg. 2011;113(5):1218–1225. doi: 10.1213/ANE.0b013e3182303a1a.
    1. Fitzgerald GS, Jr, Ahmad S, Kim J, Rahangdale R, McCarthy R. Transversus abdominis plane infiltration for laparoscopic gastric banding: a pilot study. World J Gastrointest Surg. 2014;6(2):27–32. doi: 10.4240/wjgs.v6.i2.27.
    1. Rahangdale R, Kendall MC, McCarthy RJ, et al. The effects of perineural versus intravenous dexamethasone on sciatic nerve blockade outcomes: a randomized, double-blind, placebo-controlled study. Anesth Analg. 2014;118(5):1113–1119. doi: 10.1213/ANE.0000000000000137.
    1. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000;84(1):11–15. doi: 10.1093/oxfordjournals.bja.a013366.
    1. Kluivers KB, Hendriks CJ, Mol BW, et al. Clinimetric properties of 3 instruments measuring postoperative recovery in a gynaecologic surgical population. Surgery. 2008;144(1):12–21. doi: 10.1016/j.surg.2008.03.027.
    1. McIntosh S, Adams J. Anxiety and quality of recobery in day surgery: a questionnaire study using Hospital Anxiety and Depression scale and Quality of Recovery Score. Int J Nurs Pract. 2011;17(1):85–92. doi: 10.1111/j.1440-172X.2010.01910.x.
    1. Leslie K, Troedel S, Irwin K, et al. Quality of recovery from anesthesia in neurosurgical patients. Anesthesiology. 2003;99(5):85–92. doi: 10.1097/00000542-200311000-00024.
    1. Ergun M, Berkers AW, van der Jagt MF, et al. Components of pain assessment after laparoscopic donor nephrectomy. Acta Anaesthesiol Scand. 2014;58(2):219–222. doi: 10.1111/aas.12236.
    1. Kirov K, Motamed C, Combes X, Duvaldestin P, Dhonneur G. Sensibility to atracurium of the lateral abdominal muscles. Ann Fr Anesth Réanim. 2000;19:734–738. doi: 10.1016/S0750-7658(00)00314-2.
    1. Lindekaer AL, Halvor Springborg H, Istre O. Deep neuromuscular blockade leads to a larger intraabdominal volume during laparoscopy. J Vis Exp. 2013;76:e50045.
    1. Myles PS, Myles DB, Galagher W, Chew C, MacDonald N, Dennis A. Minimal clinically important difference for three quality of recovery scales. Anesthesiology. 2016;125(1):39–45. doi: 10.1097/ALN.0000000000001158.

Source: PubMed

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