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Anaesthesiology Intensive Therapy
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2/2024
vol. 56
 
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abstract:
Original article

Evaluation of surgical condition during laparoscopic gynaecological surgery in patients with moderate vs. deep neuromuscular block in low-pressure pneumoperitoneum

Umairah Esa
1
,
Rhendra Hardy Mohamad Zaini
1
,
Mohd Zulfakar Mazlan
1
,
Ahmad Akram Omar
2
,
Sanihah Che Omar
1
,
Anas Rosedi
3

  1. Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
  2. Department of Obstetrics and Gynaecology, School of Medical Sciences, Health Campus, University of Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
  3. Department of Community Medicine, School of Medical Sciences, Health Campus, University of Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
Anaesthesiol Intensive Ther 2024; 56, 2: 121–128
DOI: https://doi.org/10.5114/ait.2024.141209
Online publish date: 2024/07/23
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Introduction:
The significant effect of deep neuromuscular block (NMB) in laparoscopic surgery is still controversial, especially in lower-pressure pneumoperitoneum. This study investigates the effect of deep neuromuscular block on intraabdominal pressure (IAP), surgical space quality, post-operative abdominal pain, and shoulder tip pain in laparoscopic gynaecological surgery.

Material and methods:
This is a randomised, double-blinded control trial which randomised samples to moderate NMB (train-of-four count [TOF] of 1 or 2) or deep NMB (post-tetanic count [PTC] of 1 or 2). Surgery began with IAP 8 mmHg but was allowed to increase the pressure if the surgical condition was unfavourable. The surgical condition was rated on a 4-point scale. Post-operative abdominal pain and shoulder tip pain was assessed using a numerical rating scale for pain, with 0 defined as no pain and 10 severe pain at recovery area (time 0), 30 minutes, and 24 hours post-operation.

Results:
Seventy patients completed the study. The rate of increasing IAP between the 2 groups (P = 0.172) is not significant, but deep NMB requires less pressure – mean highest IAP of 10.31 (± 1.39) mmHg, moderate NMB 11.54 (± 1.69) mmHg. The mean surgical space condition score was significantly better in the deep NMB group at 2.4 (± 0.7) compared to moderate NMB at 3.2 (± 0.66), P < 0.005. There was a significantly lower post-operative abdominal pain score in deep NMB but no significant difference in shoulder tip pain score between the 2 groups.

Conclusions:
Deep NMB enables the usage of lower IAP in laparoscopic surgery without interfering with surgical space condition, and it reduces the post-operative abdominal pain score in 24 hours compared to moderate NMB.

keywords:

laparoscopic surgery, lower-pressure pneumoperitoneum, deep neuromuscular block
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