Objective: To evaluate the effect of deep neuromuscular block combined with low pneumoperitoneum pressure on the postoperative recovery quality among elderly patients undergoing laparoscopic radical colorectal surgery.
Methods: Eighty-six patients who underwent laparoscopic radical colorectal surgery were enrolled in the study, 44 males and 42 females, aged 65-80 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ-Ⅲ. Patients were randomly assigned to either the deep neuromuscular block combined with low pneumoperitoneum pressure group (group L) or the control group (group C), 43 patients in each group. In group L, deep neuromuscular block was maintained during the operation, defined as a post-tetanic count (PTC) of 1-2, with pneumoperitoneum pressure maintained at 9 mmHg. In group C, moderate neuromuscular blockade was maintained during the operation, defined as a train-of-four (TOF) count of 1-2, and pneumoperitoneum pressure was kept at 14 mmHg. The primary outcome was the 15-item quality of recovery (QoR-15) scale assessed on the 1st postoperative day. Secondary outcomes included the QoR-15 scale on 3rd postoperative day, intraoperative utilization of anesthetic agents, arterial blood pH, BE, PaCO2, and PaO2 before anesthesia induction, 1 hour after pneumoperitoneum initiation, and before leaving the operating room, the surgeon's evaluation of laparoscopic surgical conditions, the first exhaust time, incidence of incisional pain, shoulder pain, and visceral pain within 24 hours postoperatively, and sufentanil consumption in the postoperative analgesic pump.
Results: Compared with group C, the total scores for QoR-15, as well as the subscales of physical comfort and pain were significantly higher on the 1st and 3rd day after surgery (P < 0.05), the intraoperative administration of rocuronium and sugammadex sodium were significantly increased (P < 0.05), PaCO2 decreased significantly 1 hour after pneumoperitoneum (P < 0.05) , the first exhaust times were shorter (P < 0.05), the incidence of postoperative shoulder pain was reduced (P < 0.05), and sufentanil consumption in patient-controlled analgesia (PCA) 24 and 48 hours after surgery were decreased in group L (P < 0.05).
Conclusion: The anesthesia management of deep neuromuscular block combined with low pneumoperitoneum pressure improves early postoperative recovery quality in older patients undergoing laparoscopic radical colorectal surgery. |
