Comparison of Operating Conditions, Postoperative Pain and Recovery, and Overall Satisfaction of Surgeons with Deep vs. No Neuromuscular Blockade for Spinal Surgery under General Anesthesia: A Prospective Randomized Controlled Trial

Abstract

We aimed to investigate operating conditions, postoperative pain, and overall satisfaction of surgeons using deep neuromuscular blockade (NMB) vs. no NMB in patients undergoing lumbar spinal surgery under general anesthesia. Eighty-three patients undergoing lumbar fusion were randomly assigned to receive deep NMB (n = 43) or no NMB (n = 40). In the deep-NMB group, rocuronium was administered to maintain deep NMB (train-of-four count 0, post-tetanic count 1–2) until the end of surgery. In the no-NMB group, sugammadex 4 mg/kg at train-of-four (TOF) count 0–1 or sugammadex 2 mg/kg at TOF count ≥2 was administered to reverse the NMB 10 min after placing the patient prone. Peak inspiratory airway pressure, plateau airway pressure, lumbar retractor pressure significantly were lower in the deep-NMB group. Degree of surgical field bleeding (0–5), muscle tone (1–3), and satisfaction (1–10) rated by the surgeon were all superior in the deep-NMB group. Pain scores, rescue fentanyl consumption in post-anesthesia care unit (PACU), and postoperative patient-controlled analgesia consumption were significantly lower in the deep-NMB group, and this group had a shorter length of stay in PACU. Compared to no NMB, deep NMB provides better operating conditions, reduced postoperative pain and higher overall satisfaction in lumbar spinal surgery.

Comparison between the trapezius and adductor pollicis muscles as an acceleromyography monitoring site for moderate neuromuscular blockade during lumbar surgery

“…Despite maintaining the BIS within 40-60, the average propofol infusion rate in group A was higher than that in group T, which was consistent with previous results 16 . The reason for this result is unclear, although it is likely due to the shallower NMB in group A, which falsely elevating the BIS values of the patients through higher electromyographic activity, resulting in a higher infused dose of propofol.…”

“…These ndings may extend to lumbar surgery because relaxed lumbar spine muscles could provide better surgical conditions. Recently, a study investigating surgical conditions of lumbar surgery presented that deep NMB provided better surgical conditions with lower lumbar retractor pressure and higher overall satisfaction score evaluated by surgeons than no NMB 16 . We observed outcomes that were consistent with those reported previously; compared with group A, in the group T, which manifested deeper NMB, the overall surgical satisfaction score evaluated by the surgeon was superior, and the lumbar muscle tone and lumbar retractor pressure were lower, which resulted in better surgical conditions in group T. Hence, the acceleromyography at the trapezius could more accurately re ect the actual NMB values in the lumbar spine muscles than that of the adductor pollicis muscle.…”

Effect of intraoperative neuromuscular blockade on postoperative sore throat and hoarseness in patients undergoing spinal surgery: a prospective observational study

“…A few studies have investigated the effect of NMB on intraoperative and postoperative outcomes during spinal surgery 2,3 . They mainly evaluated surgical conditions and recovery profiles according to the depth of NMB, but did not address postoperative sore throat and hoarseness.…”

“…Neuromuscular blocking agents are routinely used to facilitate tracheal intubation during induction of anesthesia and are commonly used to improve surgical conditions during the maintenance of general anesthesia. However, there have also been several concerns about their effectiveness in improving surgical conditions and side effects, including delayed recovery, residual paralysis, and hypersensitivity reactions [1][2][3][4] .…”

Advantages and pitfalls of clinical application of sugammadex

“…However, studies on post-surgical outcomes are recent. Oh et al [ 92 ] reported that deep NMB not only improved the surgical condition but also reduced postoperative pain in lumbar spinal surgery. Mulier and Dillemans [ 93 ] revealed that continuous deep NMB is an independent factor associated with fewer complications after bariatric surgery.…”