Abstract
Acceleromyography at the adductor pollicis located in a distal part of the body may not reflect the degree of neuromuscular blockade (NMB) at the proximally located muscles manipulated during lumbar surgery. We investigated the usefulness and characteristics of acceleromyographic monitoring at the trapezius for providing moderate NMB during lumbar surgery. Fifty patients were randomized to maintain a train-of-four count 1–3 using acceleromyography at the adductor pollicis (group A; n = 25) or the trapezius (group T; n = 25). Total rocuronium dose administered intraoperatively [mean ± SD, 106.4 ± 31.3 vs. 74.1 ± 17.6 mg; P < 0.001] and surgical satisfaction (median [IQR], 7 [5–8] vs. 5 [4–5]; P < 0.001) were significantly higher in group T than group A. Lumbar retractor pressure (88.9 ± 12.0 vs. 98.0 ± 7.8 mmHg; P = 0.003) and lumbar muscle tone in group T were significantly lower than group A. Time to maximum block with an intubating dose was significantly shorter in group T than group A (44 [37–54] vs. 60 [55–65] sec; P < 0.001). Other outcomes were comparable. Acceleromyography at the trapezius muscle during lumbar surgery required a higher rocuronium dose for moderate NMB than the adductor pollicis muscle, thereby the consequent deeper NMB provided better surgical conditions. Trapezius as proximal muscle may better reflect surgical conditions of spine muscle.
Highlights
Acceleromyography at the adductor pollicis located in a distal part of the body may not reflect the degree of neuromuscular blockade (NMB) at the proximally located muscles manipulated during lumbar surgery
A main benefit is that it enables NMB monitoring of the proximal muscles, such as lumbar spine muscles, to be measured as closed to the actual value during spine surgery, given the superior surgical condition in the trapezius group
Moderate NMB maintenance (TOF count 1–3) based on the trapezius required infusion of relatively high rocuronium dose than that required for NMB maintenance based on the adductor pollicis muscle
Summary
Acceleromyography at the adductor pollicis located in a distal part of the body may not reflect the degree of neuromuscular blockade (NMB) at the proximally located muscles manipulated during lumbar surgery. Acceleromyography at the trapezius muscle during lumbar surgery required a higher rocuronium dose for moderate NMB than the adductor pollicis muscle, thereby the consequent deeper NMB provided better surgical conditions. We investigated the usefulness and characteristics of NMB monitoring using acceleromyography at the trapezius by assessing the following: total rocuronium dose administered intraoperatively, time to maximum block with an intubating dose, intubating conditions, lumbar retractor pressure, degree of lumbar muscle tone, overall surgical satisfaction score, and the postoperative pain score between the patient groups with. We hypothesised that neuromuscular monitoring at the trapezius would require a higher rocuronium dose than that required for neuromuscular monitoring at the adductor pollicis muscle to maintain moderate NMB intraoperatively, which would provide better surgical conditions
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