Influence of deep neuromuscular block on the surgeonś assessment of surgical conditions during laparotomy: a randomized controlled double blinded trial with rocuronium and sugammadex

Abstract

Abstract Background During laparotomy, surgeons may experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. Deep neuromuscular block (NMB), defined as a post-tetanic-count (PTC) between 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesized that deep NMB (PTC 0-1) would improve subjective ratings of surgical conditions during upper laparotomy as compared with standard NMB. Methods This was a double blinded, randomized study. A total of 128 patients undergoing elective upper laparotomy were randomized to either continuous deep NMB (infusion of rocuronium 2 mg ml−1) or standard NMB (bolus of rocuronium 10 mg or increased depth of anaesthesia). Surgical conditions were evaluated using a 5-point subjective rating scale (1: extremely poor, 5: optimal) every 30 min. Primary outcome was the average of scores for a patient's surgical conditions. Other outcomes were surgical rating score during fascial closure, episodes of a need to optimize surgical conditions, occurrence of wound dehiscence, and wound infection. Results Deep compared with standard NMB resulted in better ratings of surgical conditions; median 4.75 (range 3–5) compared with 4.00 (range 1–5) (P Conclusions Deep NMB compared with standard NMB resulted in better subjective ratings of surgical conditions during laparotomy. Clinical trial registration NCT02140593.