Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1405
Peer-review started: March 14, 2023
First decision: April 7, 2023
Revised: April 20, 2023
Accepted: June 2, 2023
Article in press: June 2, 2023
Published online: July 27, 2023
Few studies have examined the specific efficacy of deep neuromuscular blockade (NMB) combined with pneumoperitoneal pressure reduction in laparoscopic radical gastrectomy (LRG) in the elderly.
To investigate the application effect of deep neuromuscular blockade (NMB) combined with reduced pneumoperitoneum pressure in LRG for gastric cancer (GC) in elderly patients and its influence on inflammation.
Totally 103 elderly patients with GC treated in our hospital between January 2020 and January 2022 were retrospectively analyzed. Among them, 45 patients treated with surgery based on deep NMB and conventional pneumoperitoneum pressure were assigned to the control group, while the rest of the 58 patients who underwent surgery based on deep NMB and reduced pneumoperitoneum pressure were assigned to the observation group. The two groups were compared in the changes of the Leiden-surgical rating scale score, serum tumor necrosis fact-α (TNF-α) and interleukin 6 (IL-6) before and after therapy. The visual analogue scale (VAS) was adopted for evaluating the shoulder pain of patients at 8 h, 24 h and 48 h after the operation. The driving pressure of the two groups at different time points was also compared. Additionally, the operation time, pneumoperitoneum time, infusion volume, blood loss, extubation time after surgery, resi
No significant difference was found between the two groups at the time of skin incision, 60 minutes since the operation and abdominal closure after surgery (P > 0.05). The observation group exhibited significantly lower VAS scores than the control group at 24 and 48h after surgery (P < 0.05). Additionally, the observation group had significantly lower driving pressure than the control group at 5 min and 60 min after the establishment of pneumoperitoneum (P < 0.05). Additionally, the two groups were similar in terms of the operation time, pneumoperitoneum time, infusion volume, blood loss, extubation time after surgery, residence time in the resuscitation room and TOF% = 90% time (P > 0.05), and the observation group showed significantly lower TNF-α and IL-6 Levels than the control group at 24 h after therapy (P < 0.05). Moreover, the incidence of adverse events was not significantly different between the two groups (P > 0.05), and the observation group experienced significantly less hospitalization time and postoperative expenses than the control group (P < 0.05).
Deep NMB combined with reduced pneumoperitoneum pressure can decrease the VAS score of shoulder pain and inflammatory reaction, without hindering the surgical vision and increasing adverse PACU-associated respiratory events, and can thus shorten the hospitalization time and treatment cost for patient.
Core Tip: Laparoscopic radical gastrectomy is a common operation for the treatment of gastric cancer (GC) with minimally invasive and rapid recovery. However, high pneumoperitoneum pressure during laparoscopic surgery has an adverse effect on the perioperative outcome of patients, especially in elderly patients. Deep muscle relaxation has been proved to improve the conditions of abdominal surgery and reduce postoperative pain, but it is still unclear whether deep muscle relaxation combined with low pneumoperitoneum pressure is effective in laparoscopic radical resection of GC in the elderly. In this study, we analyzed the role of deep muscle relaxation combined with low pneumoperitoneum pressure in elderly patients undergoing laparoscopic radical gastrectomy for GC and its effect on inflammation, in order to provide a reference for clinicians to choose treatment options.