Click
here to close Hello! We notice that
you are using Internet Explorer, which is not supported by Echinobase
and may cause the site to display incorrectly. We suggest using a
current version of Chrome,
FireFox,
or Safari.
Efficacy of profound versus moderate neuromuscular blockade in enhancing postoperative recovery after laparoscopic donor nephrectomy: A randomised controlled trial.
Bruintjes MHD
,
Krijtenburg P
,
Martini CH
,
Poyck PP
,
d'Ancona FCH
,
Huurman VAL
,
van der Jagt M
,
Langenhuijsen JF
,
Nijboer WN
,
van Laarhoven CJHM
,
Dahan A
,
Warlé MC
,
RELAX collaborator group
.
???displayArticle.abstract???
BACKGROUND: Profound neuromuscular blockade (NMB) during anaesthesia has been shown to reduce postoperative pain scores, when compared with a moderate block. We hypothesised that profound NMB during laparoscopic donor nephrectomy (LDN) could also improve the early quality of recovery after surgery.
OBJECTIVES: To compare the effectiveness of profound versus moderate NMB during LDN in enhancing postoperative recovery.
DESIGN: A phase IV, double-blinded, randomised controlled trial.
SETTING: Multicentre trial, from November 2016 to December 2017.
PATIENTS: A total of 101 living kidney donors scheduled for LDN were enrolled, and 96 patients were included in the analyses.
INTERVENTIONS: Patients were randomised to receive profound (posttetanic count 1 to 3) or moderate (train-of-four count 1 to 3) neuromuscular block.
MAIN OUTCOME MEASURES: The primary outcome was the early quality of recovery at postoperative day 1, measured by the Quality of Recovery-40 Questionnaire. Secondary outcomes were adverse events, postoperative pain, analgesic consumption and length-of-stay.
RESULTS: The intention-to-treat analysis did not show a difference with regard to the quality of recovery, pain scores, analgesic consumption and length-of-stay. Less intra-operative adverse events occurred in patients allocated to profound NMB (1/48 versus 6/48). Five patients allocated to a profound NMB received a moderate block and in two patients neuromuscular monitoring failed. The as-treated analysis revealed that pain scores were significantly lower at 6, 24 and 48 h after surgery. Moreover, the quality of recovery was significantly better at postoperative day 2 in patients receiving a profound versus moderate block (179.5 ± 13.6 versus 172.3 ± 19.2).
CONCLUSION: Secondary analysis indicates that an adequately maintained profound neuromuscular block improves postoperative pain scores and quality of recovery. As the intention-to-treat analysis did not reveal a difference regarding the primary endpoint, future studies should pursue whether a thoroughly maintained profound NMB during laparoscopy improves relevant patient outcomes.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02838134.
Biro,
Proposal for a Revised Classification of the Depth of Neuromuscular Block and Suggestions for Further Development in Neuromuscular Monitoring.
2019, Pubmed
Biro,
Proposal for a Revised Classification of the Depth of Neuromuscular Block and Suggestions for Further Development in Neuromuscular Monitoring.
2019,
Pubmed
Bruintjes,
Effectiveness of deep versus moderate muscle relaxation during laparoscopic donor nephrectomy in enhancing postoperative recovery: study protocol for a randomized controlled study.
2017,
Pubmed
,
Echinobase
Bruintjes,
Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis.
2017,
Pubmed
Debaene,
Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action.
2003,
Pubmed
Dindo,
Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.
2004,
Pubmed
Kim,
Effects of deep vs moderate neuromuscular block on the quality of recovery after robotic gastrectomy.
2019,
Pubmed
Kim,
Maintaining Optimal Surgical Conditions With Low Insufflation Pressures is Possible With Deep Neuromuscular Blockade During Laparoscopic Colorectal Surgery: A Prospective, Randomized, Double-Blind, Parallel-Group Clinical Trial.
2016,
Pubmed
Koo,
Effects of depth of neuromuscular block on surgical conditions during laparoscopic colorectal surgery: a randomised controlled trial.
2018,
Pubmed
Koo,
Randomized Clinical Trial of Moderate Versus Deep Neuromuscular Block for Low-Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy.
2016,
Pubmed
Kopman,
Laparoscopic surgery and muscle relaxants: is deep block helpful?
2015,
Pubmed
Madsen,
Postoperative shoulder pain after laparoscopic hysterectomy with deep neuromuscular blockade and low-pressure pneumoperitoneum: A randomised controlled trial.
2016,
Pubmed
Madsen,
Influence of deep neuromuscular block on the surgeonś assessment of surgical conditions during laparotomy: a randomized controlled double blinded trial with rocuronium and sugammadex.
2017,
Pubmed
Martini,
Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block.
2014,
Pubmed
Mitropoulos,
Validation of the Clavien-Dindo Grading System in Urology by the European Association of Urology Guidelines Ad Hoc Panel.
2018,
Pubmed
Myles,
Validity and reliability of a postoperative quality of recovery score: the QoR-40.
2000,
Pubmed
Torensma,
Deep Neuromuscular Block Improves Surgical Conditions during Bariatric Surgery and Reduces Postoperative Pain: A Randomized Double Blind Controlled Trial.
2016,
Pubmed
Warlé,
Low-pressure pneumoperitoneum during laparoscopic donor nephrectomy to optimize live donors' comfort.
2013,
Pubmed
Wulf,
Neuromuscular blocking effects of rocuronium during desflurane, isoflurane, and sevoflurane anaesthesia.
1998,
Pubmed
Yoo,
The Intraocular Pressure under Deep versus Moderate Neuromuscular Blockade during Low-Pressure Robot Assisted Laparoscopic Radical Prostatectomy in a Randomized Trial.
2015,
Pubmed
Özdemir-van Brunschot,
Comparison of the effectiveness of low pressure pneumoperitoneum with profound muscle relaxation during laparoscopic donor nephrectomy to optimize the quality of recovery during the early post-operative phase: study protocol for a randomized controlled clinical trial.
2015,
Pubmed
Özdemir-van Brunschot,
Quality of Recovery After Low-Pressure Laparoscopic Donor Nephrectomy Facilitated by Deep Neuromuscular Blockade: A Randomized Controlled Study.
2017,
Pubmed