Abstract
BackgroundThe use of neuromuscular blocking agents has previously been suggested to facilitate the dissection of the latissimus dorsi muscle during breast reconstructive surgery. The aim of this study was to quantify the influence of deep muscle relaxation on the force required to lift the latissimus dorsi muscle during flap preparation.MethodsAfter ethics approval and written informed consent 15 patients scheduled for elective breast reconstruction with a latissimus dorsi pedicled flap (muscle flap, not myocutaneous flap) under general anaesthesia were prospectively included. Midway through the muscle dissection a sterile cotton tape was slung around the mid portion of the muscle and connected with a sterile strain gauge stably positioned just above the patient. Thereafter, the muscle was lifted by moving the strain gauge vertically upwards until a muscle tension similar to that created manually during muscle dissection was achieved. The force (N) and distance required to tension the muscle were recorded and the tension released. In a randomized and blinded crossover design either rocuronium (0.6 mg.kg-1) or normal saline were given intravenously, and the tension protocol was repeated 2 min after each drug administration.ResultsMuscle relaxation significantly reduced the force for flap tensioning (median [percentiles] – 22 [-32/-13] %; P = 0.011) in 10/15 patients. However, in the remaining 5 patients no significant effect was measured. Normal saline had no effect on the measured force.ConclusionsDeep muscle relaxation significantly reduces the force required to manually elevate the latissimus dorsi muscle during its dissection in the majority of but not all patients.Trial registrationThe study was retrospectively registered on [17.6.2014] with the Australian and New Zealand Clinical Trials Registry. ACTRN12614000637640
Highlights
The use of neuromuscular blocking agents has previously been suggested to facilitate the dissection of the latissimus dorsi muscle during breast reconstructive surgery
After identification of the neurovascular bundle, neuromuscular blocking agents (NMBA) have been suggested to facilitate the dissection of the latissimus dorsi (LD) muscle for breast reconstructive surgery [2]
It was aim of this study to investigate the influence of deep muscle relaxation on the manual force required during muscle dissection
Summary
The use of neuromuscular blocking agents has previously been suggested to facilitate the dissection of the latissimus dorsi muscle during breast reconstructive surgery. The aim of this study was to quantify the influence of deep muscle relaxation on the force required to lift the latissimus dorsi muscle during flap preparation. The usefulness of neuromuscular blocking agents (NMBA) for plastic and reconstructive surgery has not yet been formally investigated. After identification of the neurovascular bundle, NMBA have been suggested to facilitate the dissection of the latissimus dorsi (LD) muscle for breast reconstructive surgery [2]. It was aim of this study to investigate the influence of deep muscle relaxation on the manual force required during muscle dissection
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