A narrative review on the potential benefits and limitations of deep neuromuscular blockade

Richebé, Philippe; Bousette, Nicolas; Fortier, Louis‐Philippe

doi:10.1016/j.accpm.2021.100915

Cited by 11 publications

(5 citation statements)

References 40 publications

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“…The improved surgical conditions can enable the surgeon to operate more precisely and avoid accidental tissue and organ trauma. Multiple studies have shown similar results [1,3,17,26,27]. LSG entails removing the greater curvature of the stomach within a confined abdominal space, followed by meticulous suturing of the wound edge.…”

Section: Upper Abdominal Laparoscopic Procedures May Results In Trans...mentioning

confidence: 85%

Effect of deep neuromuscular block on the quality of early recovery after sleeve gastrectomy in obese patients: a randomized controlled trial

Yang,

Wen,

et al. 2024

BMC Anesthesiol

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Background Deep neuromuscular block (NMB) has been shown to improve surgical conditions and alleviate post-operative pain in bariatric surgery compared with moderate NMB. We hypothesized that deep NMB could also improve the quality of early recovery after laparoscopic sleeve gastrectomy (LSG). Methods Eighty patients were randomized to receive either deep (post-tetanic count 1–3) or moderate (train-of-four count 1–3) NMB. The QoR-15 questionnaire was used to evaluate the quality of early recovery at 1 day before surgery (T0), 24 and 48 h after surgery (T2, T3). Additionally, we recorded diaphragm excursion (DE), postoperative pain, surgical condition, cumulative dose of analgesics, time of first flatus and ambulation, post-operative nausea and vomiting, time of tracheal tube removal and hospitalization time. Main results The quality of recovery was significantly better 24 h after surgery in patients who received a deep versus moderate block (114.4 ± 12.9 versus 102.1 ± 18.1). Diaphragm excursion was significantly greater in the deep NMB group when patients performed maximal inspiration at T2 and T3 (P < 0.05). Patients who underwent deep NMB reported lower visceral pain scores 40 min after surgery; additionally, these patients experienced lower pain during movement at T3 (P < 0.05). Optimal surgical conditions were rated in 87.5% and 64.6% of all measurements during deep and moderate NMB respectively (P < 0.001). The time to tracheal tube removal was significantly longer in the deep NMB group (P = 0.001). There were no differences in other outcomes. Conclusion In obese patients receiving deep NMB during LSG, we observed improved QoR-15 scores, greater diaphragmatic excursions, improved surgical conditions, and visceral pain scores were lower. More evidence is needed to determine the effects of deep NMB on these outcomes. Trial registration ChiCTR2200065919. Date of retrospectively registered: 18/11/2022.

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Section: Upper Abdominal Laparoscopic Procedures May Results In Trans...mentioning

confidence: 85%

Effect of deep neuromuscular block on the quality of early recovery after sleeve gastrectomy in obese patients: a randomized controlled trial

Yang,

Wen,

et al. 2024

BMC Anesthesiol

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“…The current recommendations list the evidence for deep neuromuscular blockade as ‘limited’, and this is a reflection of the current state of evidence, with both proponents and adversaries of deep blockade being able to make a good scientific argument, and evidence remaining equivocal 136 . A collaboration of European researchers has started the EURO-RELAX trial, hoping to bring new large-scale evidence to the table (ClinicalTrials.gov registration NCT04124757) 137 …”

Section: Discussionmentioning

confidence: 99%

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Lirk,

Badaoui,

Stuempflen

et al. 2024

European Journal of Anaesthesiology

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Colorectal cancer is the second most common cancer diagnosed in women and third most common in men. Laparoscopic resection has become the standard surgical technique worldwide given its notable benefits, mainly the shorter length of stay and less postoperative pain. The aim of this systematic review was to evaluate the current literature on postoperative pain management following laparoscopic colorectal surgery and update previous procedure-specific pain management recommendations. The primary outcomes were postoperative pain scores and opioid requirements. We also considered study quality, clinical relevance of trial design, and a comprehensive risk–benefit assessment of the analgesic intervention. We performed a literature search to identify randomised controlled studies (RCTs) published before January 2022. Seventy-two studies were included in the present analysis. Through the established PROSPECT process, we recommend basic analgesia (paracetamol for rectal surgery, and paracetamol with either a nonsteroidal anti-inflammatory drug or cyclo-oxygenase-2-specific inhibitor for colonic surgery) and wound infiltration as first-line interventions. No consensus could be achieved either for the use of intrathecal morphine or intravenous lidocaine; no recommendation can be made for these interventions. However, intravenous lidocaine may be considered when basic analgesia cannot be provided.

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“…However, considering the hazards of PRNB, no consensus has been reached as to the optimal degree of muscle relaxation in clinical practice. 5 , 7 , 10 , 11 Moreover, few studies have discussed the effects of TAPB on abdominal muscle relaxation. Will TAPB alter the intraoperative tension of abdominal muscles and diaphragm, which further affects the surgical field?…”

Section: Introductionmentioning

confidence: 99%

Influence of Transverse Abdominis Plane Block on Intraoperative Diaphragmatic and Respiratory Functions in Patients Receiving Laparoscopic Colorectal Surgery

Zhang,

Guo,

Gong

et al. 2024

TCRM

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Background The positive roles of deep muscle relaxation in abdominal surgeries and transversus abdominis plane block (TAPB) in the postoperative analgesia. This study aimed to discuss the effects of TAPB on abdominal muscle relaxation, the intraoperative diaphragmatic, and the respiratory functions. Methods The patients were randomly divided into the TAPB group who received single-shot TAPB bilaterally (n=30), and the control group who did not receive TAPB (n=30). Both groups keep the same steps for other procedures in the surgeries and anesthesia. Four time points for monitoring were defined: The moment when pneumoperitoneum pressure stabilized following endotracheal intubation and anesthetic induction (T0), appearance of the first incisure in the pressure-volume (P-V) loop (T1), appearance of the second incisure in the P-V loop (T2), and the moment with single stimulation (SS) =20% (T3). Primary observation parameters were SS1 measured by muscle relaxation monitoring at T1, and SS2 at T2. Secondary observation parameters included surgeon’s satisfaction with surgical field and respiratory dynamics at the four time points. Results The two groups were comparable in age, gender, BMI, ASA grade, and operation time. The TAPB group had a dramatic reduction in the total dose of intraoperative sufentanil (0.73±0.21 ug/kg) compared with the control group (0.87±0.18 ug/kg) (P=0.023); Other use of drug did not differ between the two groups. The two groups did not differ significantly in SS at either T1 (SS1) or T2 (SS2). In either group, surgeon’s satisfaction with surgical field at T1 and T2 decreased dramatically compared with T0 and T3 (all P<0.05). At each time point, the respiratory dynamics and the surgeon’s satisfaction with surgical field did not differ significantly between the two groups. Conclusion TAPB reduced the use of intraoperative analgesics without altering the degree of abdominal relaxation, or affecting surgeon’s satisfaction with surgical field in the patients receiving laparoscopic colorectal surgery.

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A narrative review on the potential benefits and limitations of deep neuromuscular blockade

Cited by 11 publications

References 40 publications

Effect of deep neuromuscular block on the quality of early recovery after sleeve gastrectomy in obese patients: a randomized controlled trial

Effect of deep neuromuscular block on the quality of early recovery after sleeve gastrectomy in obese patients: a randomized controlled trial

PROcedure-SPECific postoperative pain management guideline for laparoscopic colorectal surgery

Influence of Transverse Abdominis Plane Block on Intraoperative Diaphragmatic and Respiratory Functions in Patients Receiving Laparoscopic Colorectal Surgery

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