Kathopoulis Nikolaos, Protopapas Athanasios, Stamatakis Emmanouil, Chatzipapas Ioannis, Zacharakis Dimitrios, Grigoriadis Themos, Athanasiou Stavros, Valsmidis Dimitrios
Department of Obstetrics and Gynaecology, Alexandra Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece.
Department of Anesthesia, Alexandra Hospital, 11528 Athens, Greece.
J Pers Med. 2022 Apr 1;12(4):561. doi: 10.3390/jpm12040561.
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.
探讨在接受妇科腹腔镜手术的患者中，与中度神经肌肉阻滞（NMB）相比，深度NMB是否能改善手术条件和术后疼痛。方法：对腹腔镜妇科手术患者进行单盲、随机、对照试验，将患者随机分为以下两组：第一组患者接受深度NMB（PTC 0-1），另一组接受中度NMB（TOF 0-1）。主要结局包括使用四级量表评估手术条件，范围从0（极差）到3（最佳），并使用五级李克特量表和镇痛药物消耗量评估患者的术后疼痛。结果：144例患者分析如下：73例患者接受深度NMB，71例接受中度NMB。两组之间的平均手术视野评分相当（中度为2.44，深度NMB为2.68）。关于术后疼痛评分，深度NMB组患者的疼痛明显低于中度NMB组（0.79对1.58，p < 0.001）。此外，比较镇痛药物消耗量时，中度NMB组比深度NMB组需要更多的额外阿片类镇痛药物（18.3%对4.1%，p = 0.007）。从次要终点来看，该研究的一个有趣发现是深度NMB患者的皮下气肿发生率明显较低。结论：我们的数据表明，在妇科腹腔镜手术过程中，与中度NMB相比，深度NMB在手术视野条件方面没有优势。患者可能从深度阻滞中获益，因为它可能减轻术后疼痛。
