Περίληψη:
Background: To investigate whether deep neuromuscular blockade (NMB) improves surgical conditions and postoperative pain compared to moderate block, in patients undergoing gynecologic laparoscopic surgery. Methods: A single blind, randomized, controlled trial was undertaken with laparoscopic gynecologic surgical patients, who were randomly assigned to one of the following two groups: patients in the first group received deep NMB (PTC 0-1) and in the other, moderate NMB (TOF 0-1). Primary outcomes included assessing the surgical conditions using a four-grade scale, ranging from 0 (extremely poor) to 3 (optimal), and patients’ postoperative pain was evaluated with a five-grade Likert scale and the analgesic consumption. Results: 144 patients were analyzed as follows: 73 patients received deep NMB and 71 moderate NMB. Mean surgical field scores were comparable between the two groups (2.44 for moderate vs. 2.68 for deep NMB). Regarding postoperative pain scores, the patients in the deep NMB experienced significantly less pain than in the group of moderate NMB (0.79 vs. 1.58, p < 0.001). Moreover, when the consumption of analgesic drugs was compared, the moderate NMB group needed more extra opioid analgesia than the deep NMB group (18.3% vs. 4.1%, p = 0.007). From the secondary endpoints, an interesting finding of the study was that patients on deep NMB had significantly fewer incidents of subcutaneous emphysema. Conclusions: Our data show that, during the performance of gynecologic laparoscopic surgery, deep NMB offers no advantage of operating filed conditions compared with moderate NMB. Patients may benefit from the deep block as it may reduce postoperative pain. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.
Συγγραφείς:
Kathopoulis, N.
Protopapas, A.
Stamatakis, E.
Chatzipapas, I.
Zacharakis, D.
Grigoriadis, T.
Athanasiou, S.
Valsmidis, D.
Λέξεις-κλειδιά:
diclofenac; fentanyl; hemoglobin; morphine; narcotic analgesic agent; paracetamol; propofol; rocuronium; sugammadex, abdominal pressure; adult; American Society of Anaesthesiologists score; Article; bilateral ovarian cystectomy; bloating; body mass; comparative study; continuous infusion; controlled study; deep endometriosis node resection; deep neuromuscular blockade; demography; electrocardioscopy; end tidal carbon dioxide tension; female; flatulence; four grade scale; gas volume consumption; gynecologic surgery; hospitalization; human; hysterectomy; intestine function; kinemyography; laparoscopic surgery; laparoscopy; laparotomy; Likert scale; lung artery pressure; major clinical study; male; Mean surgical field score; middle aged; motor reaction time; myomectomy; nausea; nerve stimulation; neuromuscular blocking; neuromuscular function; outcome assessment; ovarian cystectomy; oxygen exposure; postoperative pain; pressure controlled ventilation volume; pulse oximetry; randomized controlled trial; salpingooophorectomy; single blind procedure; subcutaneous emphysema; surgical technique; total lung capacity; Trendelenburg gait; ulnar nerve; visual field scoring
