Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial

Springer Science and Business Media LLC
Antonio Coviello1, Marilena Ianniello1, Pasquale Buonanno1, Nausica Di Falco1, Carmine Iacovazzo1, Alfredo Maresca1, Maria V. Vargas1, Annachiara Marra1, Agostino Candice1, Gabriele Saccone1, Fulvio Zullo1, Giuseppe Servillo1
1Department of Neuroscience Reproductive Science and Dentistry, School of Medicine, Federico II University, Naples, Italy

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Abstract Background In recent years, the relationship between the advantages and disadvantages of a deep neuromuscular block (DNMB), compared to a moderate block (MNMB) in laparoscopic surgery, has been increasingly studied. Objective Evaluate the effect of D-NMB compared to M-NMB in gynecological laparoscopic surgery. Methods This was a parallel-group, double-blind, randomized clinical trial, conducted at a single center in Italy between February 2020 and July 2020. American Society of Anesthesiologist (ASA) I–II risk class patients scheduled for elective gynecological laparoscopic surgery were randomized into a 1:1 ratio to either experimental or control group. The first one included DNMB with a rocuronium bolus at the starting dose of 1.2 mg/kg and a maintenance dose (0.3–0.6 mg/kg/h). The second one included MNMB with a rocuronium bolus at the starting dose of 0.6 mg/kg, and a maintenance dose in boluses (0.15–0.25 mg/kg). The primary outcome was the intraoperative surgical condition assessed every 15 min by the surgeon as a 5-point scale. The secondary outcome was the time needed to discharge patients from post-anesthesia care unit (PACU). The tertiary outcome was the assessment of the intra-operative hemodynamic instability. A sample size of 50 patients was planned. Results One hundred five patients were assessed for eligibility, 55 were excluded. Fifty patients met the inclusion criteria and were enrolled. The average score for the operative field was 4 for the D-NMB group and 3 for the M-NMB group (p value < 0.01). The length of stay in PACU was 13 min for the DNMB group and 22 min for the MNMB group (p value = 0.02). Conclusions Deep neuromuscular block improves intraoperative surgical condition during gynecological laparoscopic surgery. Trial registration clinicalTrials.gov NCT03441828

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Lacy AM, García-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent D, Wieand H et al (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

Guillou P, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

Veldkamp R, Kuhry E, Hop W et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484

Park SK, Son YG, Yoo S, Lim T, Kim WH, Kim JT (2018) Deep vs. moderate neuromuscular blockade during laparoscopic surgery: A systematic review and meta-analysis. Eur J Anaesthesiol 35(11):867–875

Martini CH, Boon M, Bevers RF, Aarts LP, Dahan A (2014) Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block. Br J Anaesth 112:498–505

King M, Sujirattanawimol N, Danielson DR et al (2000) Requirements for muscle relaxants during radical retropubic prostatectomy. Anesthesiology 93:1392–1397

Murphy GS, Szokol JW, Marymont JH et al (2008) Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg 107:130–137

Beccaria P, Cabrini L, Garancini M et al (2008) Recurarisation in a surgical ward. Anaesth Intensive Care 36:917–918

Hristovska AM, Duch P, Allingstrup M, Afshari A (2017) Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev 8(8):CD012763

Capron F, Alla F, Hottier C, Meistelman C, Fuchs-Buder T (2004) Can acceleromyography detect low levels of residual paralysis? A probability approach to detect a mechanomyographic train-of-four ratio of 0.9. Anesthesiology 100(5):1119–1124

Honing G, Martini CH, Bom A, van Velzen M, Niesters M, Aarts L, Dahan A, Boon M (2019) Safety of sugammadex for reversal of neuromuscular block. Expert Opin Drug Saf 18(10):883–891

Eriksson LI, Sundman E, Olsson R, Nilsson L, Witt H, Ekberg O et al (1997) Functional assessment of the pharynx at rest and during swallowing in partially paralyzed humans: simultaneous videomanometry and mechanomyography of awake human volunteers. Anesthesiology 87(5):1035–1043

Williams MT, Rice I, Ewen SP, Elliott SM (2003) A comparison of the effect of two anaesthetic techniques on surgical conditions during gynaecological laparoscopy. Anaesthesia 58:574–578

Apfelbaum JL (1998) Bypassing PACU: a cost effective measure. Can J Anaesth 45:R91–R94

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