Background and Goal of Study: 

Laparoscopic cholecystectomy (LC) is one of the most common procedures performed in the world. Deep neuromuscular blockade (NMB) and low-pressure pneumoperitoneum, has recently been shown to improve surgical working conditions associated with a positive effect in recovery, reducing postoperative pain. Most studies evaluating recovery after LC, have ignored quality of recovery (QoR) from the patient’s perspective. We aimed to evaluate the QoR of patients undergoing CL in whom deep NMB was performed as part of the anaesthetic management.
Material and methods
After IRB approval 75 patients scheduled for CL (ASA I-III), 51 ± 14 years old were enrolled. The anaesthetic protocol included multimodal analgesia (NSAIDs, wound infiltration with local anaesthetics, low doses of fentanyl), prophylaxis of postoperative nausea and vomiting and dexamethasone. Deep NMB was instituted during  pneumoperitoneum (posttetanic count (PTC) of 1 or 2) and was maintained until the end of the surgery. The NMB was reversed at the end of the intervention with sugammadex at a dose of 4mg/kg, confirming the adequate recovery before extubation. The A recovery questionnaire was performed: QoR -15; maximum score of 150, before and 24 h after surgery. 
Results 
Five patients had an unpredicted admission, all of them due to surgical complications. Median pain score in PACU was 3.5 (interquartile range of 2 to 5); and 2 (interquartile range of 1 to 3) at 24 h after surgery. Six patients (8%) presented mild nausea in PACU and none at 24 h. The overall QoR-15 data decreased moderately at 24 h after surgery (Preoperative: median of 149 and interquartile range of 146-150; postoperative: median of 141 and interquartile range of 132- 146); P <0.0001. The percentage of decrease in QoR-15 in relation to baseline values ​​was 7%. The most affected parameters were in the emotional component, physical comfort and the presence of mild pain. 
Conclusion:
The application of a deep NMB in patients undergoing ambulatory LC provided an excellent postdischarge quality of recovery, with minimal pain and nausea in the early postoperative period. 


09 / Postoperative quality of recovery (QoR-15) after ambulatory laparoscopic cholecystectomy in patients with deep neuromuscular block. A prospective cohort study  
