Low pressure pneumoperitoneum versus standard pressure pneumoperitoneum in patient undergoing laparoscopic cholecystectomy with deep neuromuscular blockade: a randomized non inferiority control trial.

Laparoscopic cholecystectomy is the standard treatment for gallstone. It typically involved creating a pneumoperitoneum , most commonly at standard pressure of 12 to 15 mug to improve visualisation and working space. However, higher pressure associated with adverse effect such as shoulder pain, cardiovascular and respiratory issues. Recent studies suggest that low pressure pneumoperitoneum (7-10 mmhg) when combined with deep neuromuscular blockade may reduce these complication while maintaining adequate surgical field conditions. While low pressure pneumoperitoneum may reduce perioperative morbidity, there are concerns with relations to the standard of the surgical field and procedure duration. Deep NMB can potentially counteract these issues by providing better muscle relaxation. This study aims to evaluate if low pressure pneumoperitoneum with deep neuromuscular blockade is non inferior to standard pressure pneumoperitoneum in terms of surgical field quality while offering benifits in reducing post operative pain and comlocations