Optimising abdominal space with deep neuromuscular blockade in gynaecologic laparoscopy: a randomised, blinded crossover study

TY - JOUR

T1 - Optimising abdominal space with deep neuromuscular blockade in gynaecologic laparoscopy

T2 - a randomised, blinded crossover study

AU - Madsen, Matias Vested

AU - Gätke, M R

AU - Springborg, H H

AU - Rosenberg, J

AU - Lund, J.

AU - Istre, O

N1 - © 2015 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Background Insufflation of the abdomen during laparoscopy improves surgical space, but may cause post-operative shoulder pain. The incidence of shoulder pain is reduced using a lower insufflation pressure, but this may, however, compromise the surgical space. We aimed at investigating whether deep neuromuscular blockade (NMB) would enlarge surgical space, measured as the distance from the sacral promontory to the trocar in patients undergoing gynaecologic laparoscopy. Methods Fourteen patients were randomised in an assessor-blinded crossover design. The distance from the sacral promontory to the trocar was measured during deep NMB and without NMB at pneumoperitoneum 8 and 12 mmHg both. Additionally, we assessed surgical conditions while suturing the abdominal fascia using a 4-point subjective rating scale. Deep NMB was established with rocuronium and reversed with sugammadex. Results At 12 mmHg pneumoperitoneum, deep NMB improved surgical space with a mean of 0.33 cm (95% confidence interval 0.07-0.59) (P = 0.01, paired t-test) compared with no NMB. At 8 mmHg pneumoperitoneum deep NMB improved surgical space with a mean of 0.3 cm (95% confidence interval, 0.06-0.54) (P = 0.005) compared with no NMB. Deep NMB resulted in significantly better ratings of surgical conditions during suturing of the fascia (P = 0.03, Mann-Whitney U-test). Conclusion Deep NMB enlarged surgical space measured as the distance from the sacral promontory to the trocar. The enlargement, however, was minor and the clinical significance is unknown. Moreover, deep NMB improved surgical conditions when suturing the abdominal fascia.

AB - Background Insufflation of the abdomen during laparoscopy improves surgical space, but may cause post-operative shoulder pain. The incidence of shoulder pain is reduced using a lower insufflation pressure, but this may, however, compromise the surgical space. We aimed at investigating whether deep neuromuscular blockade (NMB) would enlarge surgical space, measured as the distance from the sacral promontory to the trocar in patients undergoing gynaecologic laparoscopy. Methods Fourteen patients were randomised in an assessor-blinded crossover design. The distance from the sacral promontory to the trocar was measured during deep NMB and without NMB at pneumoperitoneum 8 and 12 mmHg both. Additionally, we assessed surgical conditions while suturing the abdominal fascia using a 4-point subjective rating scale. Deep NMB was established with rocuronium and reversed with sugammadex. Results At 12 mmHg pneumoperitoneum, deep NMB improved surgical space with a mean of 0.33 cm (95% confidence interval 0.07-0.59) (P = 0.01, paired t-test) compared with no NMB. At 8 mmHg pneumoperitoneum deep NMB improved surgical space with a mean of 0.3 cm (95% confidence interval, 0.06-0.54) (P = 0.005) compared with no NMB. Deep NMB resulted in significantly better ratings of surgical conditions during suturing of the fascia (P = 0.03, Mann-Whitney U-test). Conclusion Deep NMB enlarged surgical space measured as the distance from the sacral promontory to the trocar. The enlargement, however, was minor and the clinical significance is unknown. Moreover, deep NMB improved surgical conditions when suturing the abdominal fascia.

KW - Abdominal Cavity

KW - Adult

KW - Androstanols

KW - Cross-Over Studies

KW - Double-Blind Method

KW - Female

KW - Gynecologic Surgical Procedures

KW - Humans

KW - Intraoperative Neurophysiological Monitoring

KW - Laparoscopy

KW - Middle Aged

KW - Neuromuscular Blockade

KW - Neuromuscular Nondepolarizing Agents

KW - Pneumoperitoneum, Artificial

KW - Sutures

KW - gamma-Cyclodextrins

U2 - 10.1111/aas.12493

DO - 10.1111/aas.12493

M3 - Journal article

C2 - 25789421

SN - 0001-5172

VL - 59

SP - 441

EP - 447

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 4

ER -