Randomized Clinical Trial to Compare the Incidence of Residual Neuromuscular Block Following Pancuronium and Atracurium Using Train of Four Ratio

Abstract

BACKGROUND: Several clinical studies have reported that significant number of patients receiving non depolarizing muscle relaxants during general anesthesia show postoperative residual neuromuscular block when assessed by neuromuscular monitor in the recovery room. The degree of residual neuromuscular block produced by non-depolarizing muscle relaxants can be evaluated by clinical tests as well as by neuromuscular monitoring y neuromuscular monitor in the recovery room. A randomized double blind clinical trial to determine and compare the incidence of postoperative residual neuromuscular block in patients receiving pancuronium and atracurium applying Train of Four ratio using Train of Four-Guard neuromuscular monitor. AIMS AND OBJECTIVES: To compare the incidence of postoperative residual neuromuscular block following pancuronium and atracurium using Train of Four Ratio in the recovery room. MATERIALS AND METHODS: Comparative randomized study done using 100 patients of age between 15-60 years belonging to either sex, ASA grade 1 and 2 with GROUP 'P'-Pancuronium was employed as the muscle relaxant, GROUP 'A'-Atracurium was employed as the muscle relaxant. Statistical analysis done using student "t" test. RESULTS: The mean duration required to attain Train of Four Ratio of 0.80 in patients with initial Train of four ratio <0.80 in group 'P' was 9.65±5.4413 min and in group 'A' was 2.8± 1.4832 min. CONCLUSION: 1. Our study concludes that the incidence of residual neuromuscular block in patients receiving pancuronium and atracurium were 40% and 10% respectively. Thus residual neuromuscular block can be a significant problem in recovery room, during the postoperative period. 2. The use of intermediate acting non depolarizing muscle relaxant like atracurium lowers the incidence of residual neuromuscular block but does not eliminate it.