Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, United States of America.
Evidence, Modeling, and Synthesis, Evidera Inc., London, England, United Kingdom.
PLoS One. 2020 Apr 16;15(4):e0231452. doi: 10.1371/journal.pone.0231452. eCollection 2020.
Deep neuromuscular blockade may facilitate the use of reduced insufflation pressure without compromising the surgical field of vision. The current evidence, which suggests improved surgical conditions compared with other levels of block during laparoscopic surgery, features significant heterogeneity. We examined surgical patient- and healthcare resource use-related outcomes of deep neuromuscular blockade compared with moderate neuromuscular blockade in adults undergoing laparoscopic surgery.
We conducted a systematic literature review according to the quality standards recommended by the Cochrane Handbook for Systematic Reviews. Randomized controlled trials comparing outcomes of deep neuromuscular blockade and moderate neuromuscular blockade among adults undergoing laparoscopic surgeries were included. A random-effects model was used to conduct pair-wise meta-analyses.
The systematic literature review included 15 studies-only 13 were analyzable in the meta-analysis and none were judged to be at high risk of bias. Compared with moderate neuromuscular blockade, deep neuromuscular blockade was associated with improved surgical field of vision and higher vision quality scores. Also, deep neuromuscular blockade was associated with a reduction in the post-operative pain scores in the post-anesthesia care unit compared with moderate neuromuscular blockade, and there was no need for an increase in intra-abdominal pressure during the surgical procedures. There were minor savings on resource utilization, but no differences were seen in recovery in the post-anesthesia care unit or overall length of hospital stay with deep neuromuscular blockade.
Deep neuromuscular blockade may aid the patient and physician surgical experience by improving certain patient outcomes, such as post-operative pain and improved surgical ratings, compared with moderate neuromuscular blockade. Heterogeneity in the pooled estimates suggests the need for better designed randomized controlled trials.
深度神经肌肉阻滞可能有助于在不影响手术视野的情况下使用较低的充气压力。与腹腔镜手术中其他阻滞水平相比，目前的证据表明深度神经肌肉阻滞具有改善手术条件的优势，但存在显著的异质性。我们研究了深度神经肌肉阻滞与成人腹腔镜手术中的中度神经肌肉阻滞相比，在手术患者和医疗资源使用相关结局方面的差异。
我们根据 Cochrane 系统评价手册推荐的质量标准进行了系统文献回顾。纳入了比较深度神经肌肉阻滞与成人腹腔镜手术中中度神经肌肉阻滞的结局的随机对照试验。使用随机效应模型进行两两荟萃分析。
系统文献回顾包括 15 项研究——只有 13 项研究可进行荟萃分析，且均未被判断为存在高偏倚风险。与中度神经肌肉阻滞相比，深度神经肌肉阻滞与改善的手术视野和更高的视觉质量评分相关。此外，与中度神经肌肉阻滞相比，深度神经肌肉阻滞与术后在麻醉后护理单元的疼痛评分降低相关，且在手术过程中无需增加腹腔内压力。资源利用方面有少量节省，但深度神经肌肉阻滞对麻醉后护理单元恢复或总住院时间无影响。
与中度神经肌肉阻滞相比，深度神经肌肉阻滞可能通过改善某些患者结局（如术后疼痛和改善的手术评分）来帮助患者和医生的手术体验。汇总估计值的异质性表明需要更好设计的随机对照试验。
