Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial

Yu-qin Long,1,2 Xi-sheng Shan,1,2 Xiao-mei Feng,3 Hong Liu,4 Fu-hai Ji,1,2 Ke Peng1,2 1Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of...

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Autores principales:	Long Y, Shan X, Feng X, Liu H, Ji F, Peng K
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	major laparoscopic surgery pneumoperitoneum pressure neuromuscular block postoperative quality recovery scale randomized controlled trial Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/5018b25f381b4629af144c4b412fa3f8
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spelling	oai:doaj.org-article:5018b25f381b4629af144c4b412fa3f82021-11-16T18:47:50ZDeep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial1178-7090https://doaj.org/article/5018b25f381b4629af144c4b412fa3f82021-11-01T00:00:00Zhttps://www.dovepress.com/deep-neuromuscular-blockade-combined-with-low-pneumoperitoneum-pressur-peer-reviewed-fulltext-article-JPRhttps://doaj.org/toc/1178-7090Yu-qin Long,1,2 Xi-sheng Shan,1,2 Xiao-mei Feng,3 Hong Liu,4 Fu-hai Ji,1,2 Ke Peng1,2 1Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China; 3Department of Anesthesiology, University of Utah Health, Salt Lake City, UT, USA; 4Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USACorrespondence: Ke PengDepartment of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, People’s Republic of ChinaTel +86-159-6215-5989Email pengke0422@163.comPurpose: Patients undergoing major laparoscopic surgery often experience significant pain and postoperative nausea and vomiting (PONV). Deep neuromuscular block (NMB) improves surgical conditions and facilitates the application of low intra-abdominal pressure (IAP), which may be beneficial for these patients. This study is designed to determine the effects of deep NMB combined with low IAP, as compared to moderate NMB combined with standard IAP, on patients’ nociceptive recovery after major laparoscopic gastrointestinal surgery.Study Design and Methods: This single-center randomized controlled trial will include 220 patients scheduled for major laparoscopic gastrointestinal surgery (lasts for ≥ 90 minutes). Patients will be randomly assigned, with a 1:1 ratio, into a deep NMB + low IAP group (train of four = 0, post-tetanic count = 1– 3, IAP = 8 mmHg) and a moderate NMB + standard IAP group (train of four = 1– 3, IAP = 12 mmHg). If the surgical workspace is inadequate, the surgeons can request a step increase of 1 mmHg in IAP during 3-min intervals. The upper limit of IAP will be set at 15 mmHg. Postoperative recovery will be assessed using the postoperative quality recovery scale (PQRS). The primary outcome of this trial is the PQRS nociceptive recovery (including pain and PONV) at postoperative day (POD) 1. The secondary outcomes include recovery in other PQRS domains at POD 1, and recovery in all PQRS domains in a post-anesthesia care unit, at POD 3 in the surgical wards, at hospital discharge, and at postoperative 30 days. For the sample size estimation, 110 patients in each group (220 in total) would be needed to detect an absolute increase rate of 20% in the PQRS nociceptive domain in the deep NMB + low IAP group at POD 1.Discussion: This study investigates the effects of deep NMB combined with low IAP on postoperative PQRS nociceptive recovery in patients undergoing major laparoscopic gastrointestinal surgery. We expect that this deep NMB + low IAP strategy would improve postoperative pain and PONV following major laparoscopic gastrointestinal surgery.Keywords: major laparoscopic surgery, pneumoperitoneum pressure, neuromuscular block, postoperative quality recovery scale, randomized controlled trialLong YShan XFeng XLiu HJi FPeng KDove Medical Pressarticlemajor laparoscopic surgerypneumoperitoneum pressureneuromuscular blockpostoperative quality recovery scalerandomized controlled trialMedicine (General)R5-920ENJournal of Pain Research, Vol Volume 14, Pp 3573-3581 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	major laparoscopic surgery pneumoperitoneum pressure neuromuscular block postoperative quality recovery scale randomized controlled trial Medicine (General) R5-920
spellingShingle	major laparoscopic surgery pneumoperitoneum pressure neuromuscular block postoperative quality recovery scale randomized controlled trial Medicine (General) R5-920 Long Y Shan X Feng X Liu H Ji F Peng K Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial
description	Yu-qin Long,1,2 Xi-sheng Shan,1,2 Xiao-mei Feng,3 Hong Liu,4 Fu-hai Ji,1,2 Ke Peng1,2 1Departments of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China; 3Department of Anesthesiology, University of Utah Health, Salt Lake City, UT, USA; 4Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USACorrespondence: Ke PengDepartment of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu, 215006, People’s Republic of ChinaTel +86-159-6215-5989Email pengke0422@163.comPurpose: Patients undergoing major laparoscopic surgery often experience significant pain and postoperative nausea and vomiting (PONV). Deep neuromuscular block (NMB) improves surgical conditions and facilitates the application of low intra-abdominal pressure (IAP), which may be beneficial for these patients. This study is designed to determine the effects of deep NMB combined with low IAP, as compared to moderate NMB combined with standard IAP, on patients’ nociceptive recovery after major laparoscopic gastrointestinal surgery.Study Design and Methods: This single-center randomized controlled trial will include 220 patients scheduled for major laparoscopic gastrointestinal surgery (lasts for ≥ 90 minutes). Patients will be randomly assigned, with a 1:1 ratio, into a deep NMB + low IAP group (train of four = 0, post-tetanic count = 1– 3, IAP = 8 mmHg) and a moderate NMB + standard IAP group (train of four = 1– 3, IAP = 12 mmHg). If the surgical workspace is inadequate, the surgeons can request a step increase of 1 mmHg in IAP during 3-min intervals. The upper limit of IAP will be set at 15 mmHg. Postoperative recovery will be assessed using the postoperative quality recovery scale (PQRS). The primary outcome of this trial is the PQRS nociceptive recovery (including pain and PONV) at postoperative day (POD) 1. The secondary outcomes include recovery in other PQRS domains at POD 1, and recovery in all PQRS domains in a post-anesthesia care unit, at POD 3 in the surgical wards, at hospital discharge, and at postoperative 30 days. For the sample size estimation, 110 patients in each group (220 in total) would be needed to detect an absolute increase rate of 20% in the PQRS nociceptive domain in the deep NMB + low IAP group at POD 1.Discussion: This study investigates the effects of deep NMB combined with low IAP on postoperative PQRS nociceptive recovery in patients undergoing major laparoscopic gastrointestinal surgery. We expect that this deep NMB + low IAP strategy would improve postoperative pain and PONV following major laparoscopic gastrointestinal surgery.Keywords: major laparoscopic surgery, pneumoperitoneum pressure, neuromuscular block, postoperative quality recovery scale, randomized controlled trial
format	article
author	Long Y Shan X Feng X Liu H Ji F Peng K
author_facet	Long Y Shan X Feng X Liu H Ji F Peng K
author_sort	Long Y
title	Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial
title_short	Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial
title_full	Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial
title_fullStr	Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial
title_full_unstemmed	Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial
title_sort	deep neuromuscular blockade combined with low pneumoperitoneum pressure for nociceptive recovery after major laparoscopic gastrointestinal surgery: study protocol for a randomized controlled trial
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/5018b25f381b4629af144c4b412fa3f8
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Deep Neuromuscular Blockade Combined with Low Pneumoperitoneum Pressure for Nociceptive Recovery After Major Laparoscopic Gastrointestinal Surgery: Study Protocol for a Randomized Controlled Trial

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