Effect of deep neuromuscular block on the quality of early recovery after sleeve gastrectomy in obese patients : a randomized controlled trial
© 2024. The Author(s)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
BMC anesthesiology - 24(2024), 1 vom: 16. März, Seite 101 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Yang, Wan-Li [VerfasserIn] |
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| Links: |
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| Themen: |
Deep neuromuscular block |
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| Anmerkungen: |
Date Completed 18.03.2024 Date Revised 19.03.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1186/s12871-024-02465-1 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM369827880 |
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| 520 | |a © 2024. The Author(s). | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a TRIAL REGISTRATION: ChiCTR2200065919. Date of retrospectively registered: 18/11/2022 | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Deep neuromuscular block | |
| 650 | 4 | |a Laparoscopic sleeve gastrectomy | |
| 650 | 4 | |a Obese | |
| 650 | 4 | |a Recovery | |
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| 700 | 1 | |a Xu, Wen-Mei |e verfasserin |4 aut | |
| 700 | 1 | |a Xu, Chi-Liang |e verfasserin |4 aut | |
| 700 | 1 | |a Yin, Wen-Qin |e verfasserin |4 aut | |
| 700 | 1 | |a Lin, Jing-Yan |e verfasserin |4 aut | |
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