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During laparoscopic surgery, moderate neuromuscular blockade along with TAPB effectively mitigates postoperative pain and provides surgical space conditions comparable to those of deep neuromuscular blockade.
A randomized clinical study published in BMC Anesthesiology depicted that the combination of moderate neuromuscular blockade with transverse abdominal plane block (TAPB) during elective laparoscopic colorectal cancer surgery can offer surgical space conditions comparable to deep neuromuscular blockade. Furthermore, it alleviates postoperative pain within four hours after surgery, minimizes the usage of muscle relaxants, and decreases the extubation time and stay in post-anesthesia care unit when neostigmine was utilized as a muscle relaxant antagonist.
Fang Ke et al. determined if moderate neuromuscular blockade + TAPB is linked with identical surgical space conditions when compared with deep neuromuscular blockade. In total, 80 people scheduled to undergo laparoscopic surgery for colorectal cancer were randomized into: (i) Control group (D group) : Received deep neuromuscular blockade , with a train-of-four count of 0 and a post-tetanic count ≥1, and (ii) Intervention group (M group): Received moderate neuromuscular blockade (train-of-four count between 1 and 3) + TAPB.
Both the study groups were given the same anesthesia management. The distance between sacral promontory and umbilical skin during surgery was compared between D and M groups. The surgical space conditions were scored as per a five-point ordinal scale. The pain scores of participants were assessed 8 hours after surgery. The distance from acral promontory to umbilical skin after pneumoperitoneum was comparable between group D (16.03 ± 2.17 cm)and group M (16.37 ± 2.78 cm).
Notably, the 95% confidence intervals of difference in distance from sacral promontory to umbilical skin between study groups were - 1.45-0.77 cm. As per the preset non-inferior standard of 1.5 cm, (- 1.45, ∞) completely fell within (- 1.50, ∞), and the non-inferior effect test was found to be qualified. Regarding surgical rating score, no profound inter-group differences were noted.
The dosage of rocuronium in group D was considerably higher when compared to group M. Compared to the D group, the M group exhibited considerably reduced pain scores 8 hours post-surgery. Hence, the use of moderate neuromuscular blockade along with TAPB appears to be beneficial for people undergoing laparoscopic colorectal surgery.
BMC Anesthesiology
The effects of moderate neuromuscular blockade combined with transverse abdominal plane block on surgical space conditions during laparoscopic colorectal surgery: a randomized clinical study
Fang Ke et al.
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