To study the outcomes of low pressure pneumoperitoneum with deep neuromuscular block versus standard pressure pneumoperitoneum in patients undergoing laparoscopic cholecystectomy for gallstone disease: A Randomized Control Trial.

Traditionally 12 to 14 mmHg is used for pneumoperitoneum in laparoscopic surgery including cholecystectomy. This pressure has adverse physiological effects like decreased cardiac return, decreased GFR, increased ventilatory pressures, and postoperative pain. Low-pressure pneumoperitoneum has been used to ameliorate the effects. However,  there is the issue of unfavorable working space. To solve this aspect the use of deep neuromuscular blockade has gained interest. In this study patients undergoing laparoscopic cholecystectomy will be randomized into low-pressure pneumoperitoneum with deep neuromuscular block group and the standard pressure pneumoperitoneum group. Primarily the ease of operation will be assessed using a predefined surgical rating scale based on a Likert scale of 1 to 5. The duration taken to complete the procedure will be recorded in both groups. Secondary outcomes like pain scores, conversion rate, time for extubation, and complications will also be assessed.

This study will be conducted as a prospective non-inferiority randomized control trial. The null hypothesis is that low-pressure pneumoperitoneum with deep neuromuscular block is inferior to standard pressure pneumoperitoneum in terms of ease of operation and duration for completion of surgery. Rejection of the null hypothesis will establish non-inferiority.