Comparison of deep and moderate neuromuscular blockade in microwave ablation of liver tumours: a randomized-controlled clinical trial

Abstract

Microwave ablation (MWA) is gaining popularity for the treatment of small primary hepatocellular carcinoma and metastatic lesions especially if patients are not candidates for surgical resection. Deep neuromuscular blockade (DMB) is perceived to improve surgical working conditions compared to moderate neuromuscular blockade (MMB) but no studies have examined the same benefits in MWA of liver tumours. This study aimed to compare the clinical outcomes of DMB and MMB in MWA of liver tumours in terms of liver excursion, performance scores by the interventional radiologists and patients, requirements of additional muscle relaxants and complications. 50 patients were recruited and 45 patients (22 in MMB group, 23 in DMB group) completed the study. The mean liver excursion for the MMB group (1.42 ± 1.83 mm) was significantly higher than the DMB group (0.26 ± 0.38 mm) (p = 0.001). The mean Leiden-Surgical Rating Scale (L-SRS) rated by the two interventional radiologists were 4.5 ± 0.59 and 3.6 ± 0.85 for the DMB and MMB groups, respectively (p = 0.01). There was also statistically significant difference on patient satisfaction scores (0–10: Extremely Dissatisfied–Extremely Satisfied) between DMB (8.74 ± 1.1) and MMB (7.86 ± 1.25) groups (p = 0.01). 5 patients from MMB group and none from DMB group required bolus relaxant during the MWA procedure. Adverse events were also noted to be more severe in the MMB group. In conclusion, DMB significantly reduced liver excursion and movement leading to improved accuracy, safety and success in ablating liver tumour.

The effects of moderate neuromuscular blockade combined with transverse abdominal plane block on surgical space conditions during laparoscopic colorectal surgery: a randomized clinical study

“…In recent years, a growing number of anesthesiologists have applied deep neuromuscular blockade technology in laparoscopic surgery to provide surgeons with better surgical space conditions so as to improve abdominal organ perfusion and alleviate postoperative pain for laparoscopic surgery [ 19 – 22 ]. The results of a meta-analysis by Bruintjes et al demonstrate that deep neuromuscular blockade improves surgical space conditions compared with moderate neuromuscular blockade in laparoscopic surgery.…”

The Effects of Moderate Neuromuscular Blockade Combined with Transverse Abdominal Plane Block on Surgical Space Conditions During Laparoscopic Colorectal Surgery: A Randomised Clinical Study

“…In recent years, a growing number of anesthesiologists have applied deep neuromuscular blockade technology in laparoscopic surgery to provide surgeons with better surgical space conditions so as to improve abdominal organ perfusion and alleviate postoperative pain for laparoscopic surgery. [19][20][21][22] The results of a meta-analysis by Bruintjes et al demonstrate that deep neuromuscular blockade improves surgical space conditions during laparoscopic surgery compared with moderate neuromuscular blockade. This study quanti ed surgical space conditions by measuring the distance from the sacral promontory to the umbilical skin.…”

Does deep neuromuscular blockade provide improved perioperative outcomes in adult patients? A systematic review and meta-analysis of randomized controlled trials

“…The type of surgeries varied, including laparoscopic surgery [19, 23-27, 29-31, 33-38, 40, 42, 43, 45-47, 49-55], laparotomy [46], orthopedic surgery [16,17,28,48], thoracoscopic surgery [14,15], laryngeal surgery [12,13,41], urological surgery [39], and interventional radiography surgery [32,44]. Except for 8 studies comparing DNMB with non-MNMB [13, 25, 29, 46-48, 50, 51], the majority of studies compared DNMB with MNMB [12, 14-17, 19, 23, 24, 26-28, 30-45, 49, 52-55].…”

“…Adverse events. Twenty-one studies reported specific perioperative adverse events, which included but were not limited to vascular and organ injury [39,44,49], respiratory complications [14,23,34,35,39,40], cardiovascular complications, digestive complications [34], postoperative nausea and vomiting [17,30,31,33,38,40,41,44,48,50,52,53], incision complications [46], postoperative delirium [17], and shoulder pain [27,38,47]. The sample size was small, and the adverse events varied.…”