deep neuromuscular block with low pressure pneumoperitoneum in laparoscopic abdominal surgeries: a randomized controlled trial

Background: postoperative pain management remains a challenge in laparoscopic abdominal surgeries. objectives: the purpose of this research was to determine the effects of deep neuromuscular blockade (nmb) in conjunction with low-pressure pneumoperitoneum )pp) on postoperative pain, surgical parameters, and recovery outcomes. methods: this randomized controlled double-blind study included 44 participants undergoing laparoscopic abdominal surgery. patients were randomized equally into two groups (22 each): group d received deep nmb, while group m received moderate nmb using cis-atracurium, through the utilization of computer-generated random numbers enclosed within sealed, opaque envelopes, following a parallel approach. regarding deep nmb, following an initial dose of 0.15 mg/kg, a continuous infusion of 0.06 - 0.12 mg/kg/hr was administered to maintain a post-tetanic count between 1 and 2, with low pp pressure of 10 - 12 mmhg. conversely, for moderate nmb, after the same initial dose of 0.15 mg/kg, the continuous infusion commenced upon the train-of-four count returning to 2, with the rate adjusted to sustain a count between 1 and 3, and standard pp pressure of 15 mmhg. the primary outcome was postoperative pain intensity as measured by numerical rating scale (nrs) scores in the post-anesthesia care unit (pacu). the secondary outcomes included postoperative pain intensity measured by nrs scores from 2 hours to 48 hours post-surgery, time to first analgesic administration, cumulative opioid consumption within the initial 48-hour postoperative period, and patient-reported satisfaction with postoperative pain management. statistical analysis using spss v26 included tests for normality (shapiro-wilks), with parametric data analyzed by t-test, non-parametric data by mann-whitney, and qualitative data by chi-square/fisher's test. results: group d experienced a considerably longer time until the first analgesic rescue compared to group m (9.82 ± 1.5 hours vs. 7.23 ± 1.19 hours, p < 0.001). morphine consumption in the first 24 hours was lower in group d (10.77 ± 1.51 mg vs. 13.09 ± 1.74 mg, p < 0.001). at 6, 8, and 12 hours postoperatively, group d exhibited significantly lower pain scores (p < 0.05). surgical duration, surgical field quality, complication rates, and patient satisfaction were comparable between groups. conclusions: deep nmb combined with low-pressure pp provided superior postoperative analgesia without compromising surgical field quality or increasing complications in laparoscopic abdominal surgeries.