The effect of low- versus normal-pressure pneumoperitoneum during laparoscopic colorectal surgery on the early quality of recovery with perioperative care according to the enhanced recovery principles (RECOVER): study protocol for a randomized controlled study

Kim I Albers, Fatih Polat, Ivo F Panhuizen, Marc M J Snoeck, Gert-Jan Scheffer, Hans D de Boer, Michiel C Warlé, Kim I Albers, Fatih Polat, Ivo F Panhuizen, Marc M J Snoeck, Gert-Jan Scheffer, Hans D de Boer, Michiel C Warlé

Abstract

Background: There is increasing evidence for the use of lower insufflation pressures during laparoscopic surgery. Deep neuromuscular blockade allows for a safe reduction in intra-abdominal pressure without compromising the quality of the surgical field. While there is considerable evidence to support superior surgical conditions during deep neuromuscular blockade, there is only a limited amount of studies investigating patient outcomes. Moreover, results are not always consistent between studies and vary between different types of laparoscopic surgery. This study will investigate the effect of low-pressure pneumoperitoneum facilitated by deep NMB on quality of recovery after laparoscopic colorectal surgery.

Methods: The RECOVER study is a multicenter double-blinded randomized controlled trial consisting of 204 patients who will be randomized in a 1:1 fashion to group A, low-pressure pneumoperitoneum (8 mmHg) facilitated by deep neuromuscular blockade (post tetanic count of 1-2), or group B, normal-pressure pneumoperitoneum (12 mmHg) with moderate neuromuscular blockade (train-of-four response of 1-2). The primary outcome is quality of recovery on postoperative day 1, quantified by the Quality of Recovery-40 questionnaire.

Discussion: Few studies have investigated the effect of lower insufflation pressures facilitated by deep neuromuscular blockade on patient outcomes after laparoscopic colorectal procedures. This study will identify whether low pressure pneumoperitoneum and deep neuromuscular blockade will enhance recovery after colorectal laparoscopic surgery and, moreover, if this could be a valuable addition to the Enhanced Recovery After Surgery guidelines.

Trial registration: EudraCT 2018-001485-42. Registered on April 9, 2018. Clinicaltrials.govNCT03608436. Registered on July 30, 2018.

Keywords: Colorectal; Deep neuromuscular block; Intra-abdominal pressure; Laparoscopic surgery; Laparoscopy; Pneumoperitoneum; Quality of recovery; Rocuronium; Sugammadex.

Conflict of interest statement

All authors have competing interests, as the study is funded by a grant received from Merck Sharpe & Dohme (see funding). Opinions expressed in the protocol and final article are those of the authors and not necessarily those of Merck Sharpe & Dohme.

Figures

Fig. 1
Fig. 1
Study flow chart

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