Low-pressure pneumoperitoneum facilitated by deep neuro­mus­cular blockade during laparoscopic donor nephrectomy is asso­ciated with reduced length of hospital stay

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D. Özdemir-van Brunschot, G.J. Scheffer, M. van der Jagt, H. Langenhuijsen, A. Dahan, J.E. Mulder, S. Willems, L.B. Hilbrands, C.J. van Laarhoven, F.A. d'Ancona, M.C. Warlé

Chair(s): dr. Robert A. Pol, vaat-en transplantatiechirurg, UMC Groningen & dr. Wojaiech G. Polak, chirurg, Erasmus MC

Thursday 10 march 2016

9:30 - 9:40h at Zaal 5 & 6

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie VIII - Klinisch chirurgisch en acuut

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Background:
The use of low intra-abdominal pressure (<10 mmHg) reduces postoperative pain scores after laparoscopic procedures. We hypothesize that the use of low-pressure pneumoperitoneum -facilitated by deep neuromuscular blockade- improves the early quality of recovery after laparoscopic donor nephrectomy.

Methods:
64 living donors scheduled for LDN were randomly assigned to low- (6mmHg) or standard (12mmHg) pressure pneumoperitoneum. A deep neuromuscular block was used in both groups. Surgeons, anesthesiologists and the research team were blinded for the allocation of treatment. Surgical conditions were rated by the surgical rating scale (SRS); ranging from 1 (very poor) to 5 (optimal). If the SRS was below 4 (good) at any point during the procedure, the intra-abdominal pressure was increased step-wise. The primary outcome measure was the overall score on the quality of recovery-40 questionnaire at postoperative day 1.

Results:
Eight procedures (24%), initially started with low-pressure, were converted to a standard pressure (≥10mmHg). There was a tendency towards a better quality of recovery-40 score on day 1 in the low-pressure group (p=0.06). Overall pain scores and analgesic consumption did not differ between the low- and standard pressure group. Low-pressure PNP was associated with earlier mobilization and physical independence (p<0.05) and a lower deep intra-abdominal pain score at day 2 (p=0.02). In the low-pressure group, 15 patients (45%) were discharged at day 2 as compared to 7 patients (20%) in the standard pressure group (p=0.03).

Conclusion:
The use of low-pressure pneumoperitoneum during LDN is associated with a shorter length of hospital stay. This finding is mainly driven by earlier mobilization and physical independence.