Deep neuromuscular blockade aids laparoscopic surgeons, but not necessarily patients

Editor's Note

Research shows a deeper neuromuscular block (NMB) can help perform complex abdominal surgeries laparoscopically without impacting intraoperative safety or patient outcomes, according to an October 20 report in MedPage Today.

Conducted across European centers and announced at the American Society of Anesthesiologists (ASA) annual meeting, the randomized trial enrolled 731 laparoscopic abdominal surgery patients from February 2020 to November 2023, MedPage reports. Researchers compared deep NMB (post-tetanic count 1-2 twitches) with standard NMB (single NMB agent at induction).

Results showed no significant difference in intraoperative adverse events (AEs) between deep and standard NMB groups, with overall AE rates of 14.9% and 18.3%, respectively, MedPage reports. Anesthesia-related AEs occurred in 7.7% of deep NMB cases versus 11.6% in the standard group, while surgical-related AEs were nearly identical (7.7% vs. 8.0%). Thirty-day postoperative complication and readmission rates were also comparable, with no significant difference in quality-of-life or recovery scores between the groups.

However, deep NMB was associated with better surgical working conditions, as rated by the Leiden Surgical Rating Scale, MedPage reports. The incidence of unfavorable surgical conditions—such as limited laparoscopic workspace or disruptive muscle movements—was significantly lower with deep NMB (1.6% vs. 10.4%, P<0.0001).

Although NMB is frequently used in practice, routine deep NMB has been more controversial due to the lack of strong evidence of real patient benefit and the associated expense of costly sugammadex to reverse the block,” MedPage reports, noting that the lead author of the study indicated that “her group is probably not changing practice based on the present results.”