MP74-20 THE USE OF A LOW-DOSE NON-DEPOLARIZING NEUROMUSCULAR BLOCKER DOES NOT AFFECT OPENING MOTOR THRESHOLDS FOR SACRAL NEUROMODULATION

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP74-20 THE USE OF A LOW-DOSE NON-DEPOLARIZING NEUROMUSCULAR BLOCKER DOES NOT AFFECT OPENING MOTOR THRESHOLDS FOR SACRAL NEUROMODULATION Courtney Nguyen, Nicholas Major, Mason Holtel, and Colin Goudelocke Courtney NguyenCourtney Nguyen More articles by this author , Nicholas MajorNicholas Major More articles by this author , Mason HoltelMason Holtel More articles by this author , and Colin GoudelockeColin Goudelocke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Succinylcholine is a popular muscle relaxant for ambulatory anesthesia and short surgical procedures. With a half-life of less than one minute, it is an excellent anesthetic agent for sacral neuromodulation (SNM) due to its quickly-dissipating properties. This allows for optimal lead placement using anal bellows and toe twitch responses that would otherwise be affected by longer-acting agents. A prominent side effect of succinylcholine is postoperative myalgias, characterized as muscle stiffness and aching that can last several days following the procedure. In very low doses, Rocuronium, a non-depolarizing muscle relaxant, is often given alongside succinylcholine to prevent muscle fasciculation and postoperative myalgia. These defasciculating doses are thought to minimally affect the neuromuscular synapse and are presumed to have minimal effects on motor response during testing. METHODS: A single-institution, IRB-approved, retrospective review was performed on all patients who underwent staged testing of Sacral Neuromodulation at Ochsner Health Center from July 2019 to July 2021 (n=121). Data collected included whether a longer-acting neuromuscular blocker (rocuronium) was used, the dose if used, and motor thresholds for bellow and toe responses for all electrodes. All leads were placed by a single surgeon (CG). Statistical analysis was performed using ANOVA and Student’s T-Test and corrected with Bonferroni. RESULTS: A defasciculating dose of rocuronium (≤10 mg) was used in 82/121. Thirty-four patients received no neuromuscular blockade. The mean opening threshold for bellow response was 0.919±0.0056 mA for patients not pre-treated with rocuronium and 0.999±0.072 mA for those that received a defasciculating dose (p=0.32). The mean opening threshold for toe response between the non-rocuronium group versus the rocuronium pretreated was 0.949±0.0036 mA and 0.958±0.00067 mA, respectively (p=0.82). CONCLUSIONS: There was no statistically significant difference between opening thresholds for bellows or toe when comparing rocuronium and non-rocuronium groups. This study suggests that rocuronium can safely be administered to reduce postoperative myalgia without altering SNM lead placement. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1078 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Courtney Nguyen More articles by this author Nicholas Major More articles by this author Mason Holtel More articles by this author Colin Goudelocke More articles by this author Expand All Advertisement PDF downloadLoading ...