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Neuromuscular blockade improves surgical conditions (NISCO)

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Abstract

Background

We examined the impact of muscle relaxation on surgical conditions and patients’ postoperative outcome during elective laparoscopic cholecystectomy under balanced anaesthesia.

Methods

After approval and consent, 57 anaesthetized patients were randomly assigned to group no neuromuscular blockade (No NMB) and deep neuromuscular blockade (Deep NMB), i.e. no twitch response to train-of-four nerve stimulation. Laparoscopic cholecystectomy was performed using the 4-trocar technique with a CO2-pneumoperitoneum. Surgical conditions were assessed using a Visual Analogue Scale. Movement of diaphragm or abdominal muscles, inadequate visibility, or breathing and coughing against the ventilator were documented as events reflecting inadequate muscle relaxation. Independently, surgeons could request 0.3 mg/kg rocuronium to improve surgical conditions. Workflow variables were obtained as a surrogate of surgical conditions. Data are presented as mean (95 % confidence interval). The trial is registered at ClinicalTrials.gov (NCT00895778).

Results

While in 12 of 25 patients of group “No NMB” one or more adverse events impaired the surgical procedure (p < 0.001), only 1 of 25 patients of group “Deep NMB” showed an adverse event. Deep NMB resulted in an absolute risk reduction of 0.44 (0.23–0.65) and a number needed to treat of 2.3 (1.5–4.4), respectively. Surgeons requested 0.3 mg/kg rocuronium in 10 of 25 cases (40 %) of group “No NMB” only. This dose significantly improved surgical conditions by an average 62 of 100 possible points. All further variables did not differ between groups.

Conclusions

Deep NMB ameliorates surgical conditions for laparoscopic cholecystectomy by improved visibility and reduction of involuntary movements.

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Disclosures

Prof. Manfred Blobner has received honoraria from GlaxoSmithKline and MSD Sharp & Dohme. Dr. Christiane Frick has received honoraria and a travel grant from MSD Sharpe & Dohme. Dr. Stefan Schaller holds stocks of the following companies in the healthcare sector in small amounts: Bayer AG, Siemens AG, GE, MERCK & CO INC, Rhoen-Klinikum AG and Fresenius SE. However, these holdings do not influence any decisions regarding the study. Dr. Heidrun Fink has received honoraria and travel grants from the following companies: MSD Sharp & Dohme, Essex, Baxter, Care Fusion, GE Healthcare. Prof. Dr. Feussner and Drs. Stäuble, Unterbuchner, Lingg and Geisler have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany

    Manfred Blobner, Christiane G. Frick, Roland B. Stäuble, Stefan J. Schaller, Christoph Unterbuchner, Charlotte Lingg, Martina Geisler & Heidrun Fink

  2. Chirurgische Klinik, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675, Munich, Germany

    Hubertus Feussner

Authors
  1. Manfred Blobner
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  2. Christiane G. Frick
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  3. Roland B. Stäuble
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  4. Hubertus Feussner
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  5. Stefan J. Schaller
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  6. Christoph Unterbuchner
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  7. Charlotte Lingg
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  8. Martina Geisler
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  9. Heidrun Fink
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Corresponding author

Correspondence to Christiane G. Frick.

Additional information

The work was performed at: Klinik für Anaesthesiologie and Chirurgische Klinik, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.

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Blobner, M., Frick, C.G., Stäuble, R.B. et al. Neuromuscular blockade improves surgical conditions (NISCO). Surg Endosc 29, 627–636 (2015). https://doi.org/10.1007/s00464-014-3711-7

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  • DOI: https://doi.org/10.1007/s00464-014-3711-7

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