Deep neuromuscular blockade during major laparoscopic surgeries might reduce postoperative pain via amelioration of the surgery-induced immune response

Abstract

ABSTRACT Objectives Evaluation of the effect of deep neuromuscular blockade (DNMB) with low abdominal insufflation pressure (AIP) during laparoscopic colectomy on serum levels of inflammatory cytokines and on wound and shoulder-tip pain (STP) scores. Patients & Methods NMB was provided as rocuronium 0.6 mg/Kg initial dose and 0.15 mg/kg as maintenance dose according to the required depth of blockade and was reversed by sugammadex 4 mg/kg. AIP was provided at 10 and 14 mm Hg for Group-D and Group-C, respectively. Blood samples were collected for ELISA estimation of cytokines’ serum levels. Results The doses of intraoperative (IO) fentanyl (p = 0.026) and postoperative (PO) morphine, and 24-h cumulative pain score were significantly lower (p = 0.025) in Group-D. The measured cytokines’ serum levels increased progressively during surgery with significantly lower percentage of increase in Group-D (p = 0.0022; 0.0043; <0.001 for IL-1β, IL-6 and TNF-α, respectively). The percentage of increase in immediate PO serum cytokines’ levels was negatively related to the depth of NMB, while it showed positive correlation with the total dose of IO fentanyl, post-anesthetic care unit (PACU) pain scores, 24-h cumulative pain score and STP scores. Statistical analyses defined DNMB and serum IL-6 levels as significant predictor for cumulative pain scores. Conclusion The use of DNMB with low AIP significantly ameliorated the impact of surgery on immune milieu, reduced IO consumption of narcotic and reduced PO pain.