Does deep neuromuscular blockade provide improved outcomes in low pressure laparoscopic colorectal surgery? A single blinded randomized pilot study

Abstract

Background: Low intra-abdominal pressure during laparoscopic colorectal surgery may improve outcomes and reduce hospital stay, in addition to Enhanced Recovery After Surgery (ERAS) protocols. There is concern that low pressure reduces laparoscopic vision and may increase surgical complications. Deep neuromuscular blockade may abrogate any reduction in vision of low-pressure pneumoperitoneum. However, antagonism of deep neuromuscular blockade at completion of surgery necessitates the use of sugammadex, which is prohibitively expensive, if there are no surgical benefits and warrants further study. Methods: A single institution, single blinded randomized controlled pilot study was performed comparing deep to moderate neuromuscular blockade in major laparoscopic colorectal surgery. Results: Thirty-eight patients were randomized to deep or moderate neuromuscular blockade. There were no statistically significant differences between groups, when comparing key patient demographics, or surgeon satisfaction with view, which required increased pressure or further relaxation demands. The deep blockade group had increased QoR15 scores and a decrease in pain, C-Reactive Protein (CRP) measurements and operating times, although were non-significant. The moderate group had slightly higher incidents of Medical Emergency Team (MET) calls and more severe complications, although were nonsignificant. Conclusions: Low intra-abdominal pressure in laparoscopic colorectal surgery is feasible and allows adequate surgical visualization, regardless of the degree of neuromuscular blockade. Potential benefits of deep neuromuscular blockade may include improved pain and quality of recovery and a possible reduction of complications; however a larger cohort is required to confirm this. Future ERAS protocols may consider deep neuromuscular blockade with low intra-abdominal pressure to further benefit patients.

Deep versus Moderate Neuromuscular Blockade in Gynecologic Laparoscopic Operations: Randomized Controlled Trial

“…Moreover, regarding patients undergoing laparoscopic gastric bypass, deep NMB markedly improved the surgical conditions compared with moderate block [17]. Finally, the latest studies in colorectal surgery suggest that deep NMB may improve postoperative pain and reduce opioid consumption, findings that agree with our results [18,19].…”

Low Intra-Abdominal Pressure with Complete Neuromuscular Blockage Reduces Post-Operative Complications in Major Laparoscopic Urologic Surgery: A before–after Study

“…These levels of IAP have been shown to increase pain and decrease organ perfusion, potentially contributing to an increase in post-operative complications [ 17 , 18 ]. Reducing IAP by itself can reduce surgical space and may not help in controlling intra-operative blood loss; thus, strategies enabling the reduction in IAP while maintaining an adequate surgical space are required [ 19 , 20 , 21 , 22 , 23 ].…”

Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery

“…The results of this study showed that the nutritional status of the body for patients in the recovery period after tracheal intubation under general anesthesia could be improved by the extremely early postoperative enteral nutrition intervention based on the ERAS theory, as measured by albumin and hemoglobin levels on the first and third postoperative days and by the fasting blood glucose value than those of the control group. This is mainly because enteral nutrition conforms to normal physiological characteristics and has the characteristics of high nitrogen utilization, which can maintain postoperative nitrogen balance, tissue and organ metabolism and functional integrity of intestinal mucosal barrier, promote gastrointestinal function recovery, reduce abdominal distension, and contribute to the prevention and treatment of anastomotic edema and postoperative delayed gastric functional emptying syndrome[ 16 , 17 ].…”