Deep Neuromuscular Block With Low Pressure Pneumoperitoneum in Laparoscopic Abdominal Surgeries

Acute-pain management in surgery patients is accompanied by an array of negative consequences, including increased morbidity, impaired physical function, and quality of life, slowed recovery, prolonged opioid use during and after hospitalization, and increased cost of care.

Reducing pneumo-peritoneum (PP) is one technique for reducing postoperative pain. The effect of low PP on postoperative pain remains a controversial topic with other studies reporting no difference in postoperative pain levels between the Two pressures.

Deep neuromuscular block (DNMB) in abdominal surgeries is associated with various advantages, such as lower abdominal pressure, lower pain and rescue opioid consumption, as well as less bleeding. DNMB may facilitate the use of reduced insufflation pressure without compromising the surgical field of vision. However, its usage is limited due to a lack of predictable and rapid recovery with conventional NMB antagonists (neostigmine) or spontaneous recovery

Inclusion criteria

• Age 18 to 65 years old.
• Both sexes.
• American Society of Anesthesiologists (ASA) physical status I-III.
• Patients scheduled for laparoscopic abdominal surgery.

Exclusion criteria

• Known allergies to cis-atracurium or neostigmine.
• Contraindications to the use of neostigmine, such as bronchial asthma, glaucoma, myocardial ischemia, and epilepsy.
• History of neuromuscular, renal, or hepatic disease; previous abdominal surgery.
• Treatment with drugs known to affect neuromuscular function.
• Preoperative hyperalgesia.
• Peripheral neuropathy is caused by diabetes.
• History of chronic analgesics treatment, drug, or alcohol abuse.
• Body mass index (BMI) > 35 kg/m2.