Deep Neuromuscular Block Improves Surgical Conditions during Bariatric Surgery and Reduces Postoperative Pain: A Randomized Double Blind Controlled Trial

It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome. The authors studied the effect of deep versus moderate NMB in laparoscopic bariatric surgery on surgical conditions and postoperative pain. One...

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Published inPloS one Vol. 11; no. 12; p. e0167907
Main Authors Torensma, Bart, Martini, Chris H., Boon, Martijn, Olofsen, Erik, in ‘t Veld, Bas, Liem, Ronald S. L., Knook, Mireille T. T., Swank, Dingeman J., Dahan, Albert
Format Journal Article
LanguageEnglish
Published United States Public Library of Science 09.12.2016
Public Library of Science (PLoS)
Subjects
Adult
Analysis
Anesthesiology
Bariatric surgery
Bariatric Surgery - adverse effects
Biology and Life Sciences
Cholecystectomy
Claudius
Clinical outcomes
Clinical trials
Confidence intervals
Double-Blind Method
Double-blind studies
Engineering and Technology
Female
Gastrointestinal surgery
Humans
Laparoscopy
Male
Medical personnel
Medicine and Health Sciences
Middle Aged
Neuromuscular Blockade
Neuromuscular blocking agents
Neuromuscular system
Obesity
Opioids
Pain
Pain, Postoperative - prevention & control
Patients
People and Places
Postoperative pain
Postoperative period
Randomization
Social Sciences
Surgeons
Surgery
Systematic review
Netherlands
Online AccessGet full text

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Abstract It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome. The authors studied the effect of deep versus moderate NMB in laparoscopic bariatric surgery on surgical conditions and postoperative pain. One hundred patients scheduled to undergo elective bariatric surgery were randomized to a deep NMB (post-tetanic-count 2-3) or a moderate NMB (train-of-four 1-2). The quality of the surgical field was scored using the Leiden-Surgical Rating Scale (L-SRS), a 5-point scale ranging from 1 (extremely poor conditions) to 5 (optimal conditions). Three surgeons scored the L-SRS at 10-min intervals during surgery; postoperative pain scores were obtained in the postanesthesia-care-unit (PACU) and on the ward. Mean (95% confidence interval) L-SRS scores in moderate NMB 4.2 (4.0-4.4) versus 4.8 (4.7-4.9) in deep NMB (p < 0.001). Moderate NMB resulted in 17% of scores at L-SRS scores of 1-3, while deep NMB resulted in 100% scores at the high end of the L-SRS (4-5). Deep NMB led to improved pain scores in the PACU (4.6 (4.2-4.9) versus 3.9 (3.6-4.4), p = 0.03) and reduced shoulder pain on the ward (1.8 (1.5-2.1) versus 1.3 (1.1-1.5), p = 0.03). A composite score of pain and opioid use in the PACU favoured deep NMB (p = 0.001). In bariatric surgery, deep relaxation has advantages for surgeon and patient. Compared to moderate NMB, deep NMB produced stable and improved surgical conditions with less postoperative pain.
AbstractList It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome. The authors studied the effect of deep versus moderate NMB in laparoscopic bariatric surgery on surgical conditions and postoperative pain. One hundred patients scheduled to undergo elective bariatric surgery were randomized to a deep NMB (post-tetanic-count 2-3) or a moderate NMB (train-of-four 1-2). The quality of the surgical field was scored using the Leiden-Surgical Rating Scale (L-SRS), a 5-point scale ranging from 1 (extremely poor conditions) to 5 (optimal conditions). Three surgeons scored the L-SRS at 10-min intervals during surgery; postoperative pain scores were obtained in the postanesthesia-care-unit (PACU) and on the ward. Mean (95% confidence interval) L-SRS scores in moderate NMB 4.2 (4.0-4.4) versus 4.8 (4.7-4.9) in deep NMB (p < 0.001). Moderate NMB resulted in 17% of scores at L-SRS scores of 1-3, while deep NMB resulted in 100% scores at the high end of the L-SRS (4-5). Deep NMB led to improved pain scores in the PACU (4.6 (4.2-4.9) versus 3.9 (3.6-4.4), p = 0.03) and reduced shoulder pain on the ward (1.8 (1.5-2.1) versus 1.3 (1.1-1.5), p = 0.03). A composite score of pain and opioid use in the PACU favoured deep NMB (p = 0.001). In bariatric surgery, deep relaxation has advantages for surgeon and patient. Compared to moderate NMB, deep NMB produced stable and improved surgical conditions with less postoperative pain.
Background It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome. The authors studied the effect of deep versus moderate NMB in laparoscopic bariatric surgery on surgical conditions and postoperative pain. Methods and Results One hundred patients scheduled to undergo elective bariatric surgery were randomized to a deep NMB (post-tetanic-count 2-3) or a moderate NMB (train-of-four 1-2). The quality of the surgical field was scored using the Leiden-Surgical Rating Scale (L-SRS), a 5-point scale ranging from 1 (extremely poor conditions) to 5 (optimal conditions). Three surgeons scored the L-SRS at 10-min intervals during surgery; postoperative pain scores were obtained in the postanesthesia-care-unit (PACU) and on the ward. Mean (95% confidence interval) L-SRS scores in moderate NMB 4.2 (4.0-4.4) versus 4.8 (4.7-4.9) in deep NMB (p < 0.001). Moderate NMB resulted in 17% of scores at L-SRS scores of 1-3, while deep NMB resulted in 100% scores at the high end of the L-SRS (4-5). Deep NMB led to improved pain scores in the PACU (4.6 (4.2-4.9) versus 3.9 (3.6-4.4), p = 0.03) and reduced shoulder pain on the ward (1.8 (1.5-2.1) versus 1.3 (1.1-1.5), p = 0.03). A composite score of pain and opioid use in the PACU favoured deep NMB (p = 0.001). Conclusions In bariatric surgery, deep relaxation has advantages for surgeon and patient. Compared to moderate NMB, deep NMB produced stable and improved surgical conditions with less postoperative pain.
Background It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome. The authors studied the effect of deep versus moderate NMB in laparoscopic bariatric surgery on surgical conditions and postoperative pain. Methods and Results One hundred patients scheduled to undergo elective bariatric surgery were randomized to a deep NMB (post-tetanic-count 2–3) or a moderate NMB (train-of-four 1–2). The quality of the surgical field was scored using the Leiden-Surgical Rating Scale (L-SRS), a 5-point scale ranging from 1 (extremely poor conditions) to 5 (optimal conditions). Three surgeons scored the L-SRS at 10-min intervals during surgery; postoperative pain scores were obtained in the postanesthesia-care-unit (PACU) and on the ward. Mean (95% confidence interval) L-SRS scores in moderate NMB 4.2 (4.0–4.4) versus 4.8 (4.7–4.9) in deep NMB (p < 0.001). Moderate NMB resulted in 17% of scores at L-SRS scores of 1–3, while deep NMB resulted in 100% scores at the high end of the L-SRS (4–5). Deep NMB led to improved pain scores in the PACU (4.6 (4.2–4.9) versus 3.9 (3.6–4.4), p = 0.03) and reduced shoulder pain on the ward (1.8 (1.5–2.1) versus 1.3 (1.1–1.5), p = 0.03). A composite score of pain and opioid use in the PACU favoured deep NMB (p = 0.001). Conclusions In bariatric surgery, deep relaxation has advantages for surgeon and patient. Compared to moderate NMB, deep NMB produced stable and improved surgical conditions with less postoperative pain.
BACKGROUNDIt remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome. The authors studied the effect of deep versus moderate NMB in laparoscopic bariatric surgery on surgical conditions and postoperative pain.METHODS AND RESULTSOne hundred patients scheduled to undergo elective bariatric surgery were randomized to a deep NMB (post-tetanic-count 2-3) or a moderate NMB (train-of-four 1-2). The quality of the surgical field was scored using the Leiden-Surgical Rating Scale (L-SRS), a 5-point scale ranging from 1 (extremely poor conditions) to 5 (optimal conditions). Three surgeons scored the L-SRS at 10-min intervals during surgery; postoperative pain scores were obtained in the postanesthesia-care-unit (PACU) and on the ward. Mean (95% confidence interval) L-SRS scores in moderate NMB 4.2 (4.0-4.4) versus 4.8 (4.7-4.9) in deep NMB (p < 0.001). Moderate NMB resulted in 17% of scores at L-SRS scores of 1-3, while deep NMB resulted in 100% scores at the high end of the L-SRS (4-5). Deep NMB led to improved pain scores in the PACU (4.6 (4.2-4.9) versus 3.9 (3.6-4.4), p = 0.03) and reduced shoulder pain on the ward (1.8 (1.5-2.1) versus 1.3 (1.1-1.5), p = 0.03). A composite score of pain and opioid use in the PACU favoured deep NMB (p = 0.001).CONCLUSIONSIn bariatric surgery, deep relaxation has advantages for surgeon and patient. Compared to moderate NMB, deep NMB produced stable and improved surgical conditions with less postoperative pain.
It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome. The authors studied the effect of deep versus moderate NMB in laparoscopic bariatric surgery on surgical conditions and postoperative pain. One hundred patients scheduled to undergo elective bariatric surgery were randomized to a deep NMB (post-tetanic-count 2-3) or a moderate NMB (train-of-four 1-2). The quality of the surgical field was scored using the Leiden-Surgical Rating Scale (L-SRS), a 5-point scale ranging from 1 (extremely poor conditions) to 5 (optimal conditions). Three surgeons scored the L-SRS at 10-min intervals during surgery; postoperative pain scores were obtained in the postanesthesia-care-unit (PACU) and on the ward. Mean (95% confidence interval) L-SRS scores in moderate NMB 4.2 (4.0-4.4) versus 4.8 (4.7-4.9) in deep NMB (p < 0.001). Moderate NMB resulted in 17% of scores at L-SRS scores of 1-3, while deep NMB resulted in 100% scores at the high end of the L-SRS (4-5). Deep NMB led to improved pain scores in the PACU (4.6 (4.2-4.9) versus 3.9 (3.6-4.4), p = 0.03) and reduced shoulder pain on the ward (1.8 (1.5-2.1) versus 1.3 (1.1-1.5), p = 0.03). A composite score of pain and opioid use in the PACU favoured deep NMB (p = 0.001). In bariatric surgery, deep relaxation has advantages for surgeon and patient. Compared to moderate NMB, deep NMB produced stable and improved surgical conditions with less postoperative pain.
Audience Academic
Author Torensma, Bart
Knook, Mireille T. T.
Olofsen, Erik
in ‘t Veld, Bas
Boon, Martijn
Liem, Ronald S. L.
Swank, Dingeman J.
Martini, Chris H.
Dahan, Albert
AuthorAffiliation 2 Department of Surgery, Dutch Obesity Clinic West, The Hague, The Netherlands
3 Department of Anesthesiology, Haaglanden Medical Center, The Hague, The Netherlands
1 Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
Cardiff University, UNITED KINGDOM
AuthorAffiliation_xml – name: 3 Department of Anesthesiology, Haaglanden Medical Center, The Hague, The Netherlands
– name: 1 Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands
– name: 2 Department of Surgery, Dutch Obesity Clinic West, The Hague, The Netherlands
– name: Cardiff University, UNITED KINGDOM
Author_xml – sequence: 1
  givenname: Bart
  surname: Torensma
  fullname: Torensma, Bart
– sequence: 2
  givenname: Chris H.
  surname: Martini
  fullname: Martini, Chris H.
– sequence: 3
  givenname: Martijn
  surname: Boon
  fullname: Boon, Martijn
– sequence: 4
  givenname: Erik
  surname: Olofsen
  fullname: Olofsen, Erik
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  surname: in ‘t Veld
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  givenname: Ronald S. L.
  surname: Liem
  fullname: Liem, Ronald S. L.
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  givenname: Mireille T. T.
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  fullname: Swank, Dingeman J.
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/27936214$$D View this record in MEDLINE/PubMed
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2016 Torensma et al 2016 Torensma et al
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Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Albert Dahan, Chris Martini and Martijn Boon received speaker fees and/or consultancy fees from MSD Nederland.
Conceptualization: AD BT CM MB DS.Data curation: BT.Formal analysis: AD CM BT EO.Funding acquisition: AD.Investigation: RL MK DS BT CM.Methodology: AD CM BT BitV MB.Project administration: BT DS.Resources: AD DS BT.Software: AD CM BT.Supervision: AD CM.Validation: AD BT.Visualization: AD BT CM.Writing – original draft: AD.Writing – review & editing: AD BT CM MB DS.
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Snippet It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome....
Background It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient...
BACKGROUNDIt remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient...
Background It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient...
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StartPage e0167907
SubjectTerms Adult
Analysis
Anesthesiology
Bariatric surgery
Bariatric Surgery - adverse effects
Biology and Life Sciences
Cholecystectomy
Claudius
Clinical outcomes
Clinical trials
Confidence intervals
Double-Blind Method
Double-blind studies
Engineering and Technology
Female
Gastrointestinal surgery
Humans
Laparoscopy
Male
Medical personnel
Medicine and Health Sciences
Middle Aged
Neuromuscular Blockade
Neuromuscular blocking agents
Neuromuscular system
Obesity
Opioids
Pain
Pain, Postoperative - prevention & control
Patients
People and Places
Postoperative pain
Postoperative period
Randomization
Social Sciences
Surgeons
Surgery
Systematic review
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Title Deep Neuromuscular Block Improves Surgical Conditions during Bariatric Surgery and Reduces Postoperative Pain: A Randomized Double Blind Controlled Trial
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http://dx.doi.org/10.1371/journal.pone.0167907
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