Title: | Efficacy of profound versus moderate neuromuscular blockade in enhancing postoperative recovery after laparoscopic donor nephrectomy: A randomised controlled trial |
Author(s): | Bruintjes, M.H.D.; Krijtenburg, P. ; Martini, Chiara; Poyck, P.; D'Ancona, F.C.H. ; Huurman, V.A.L.; Jagt, M.F. van der; Langenhuijsen, J.F. ; Nijboer, W.N.; Laarhoven, C.J.H.M. van ; Dahan, A.; Warle, M.C.; Albers, K.I. ; Donders, A.R.T. ; Hilbrands, L.B. ; Scheffer, G.J. |
Publication year: | 2019 |
Source: | European Journal of Anaesthesiology, vol. 36, iss. 7, (2019), pp. 494-501 |
ISSN: | 0265-0215 |
DOI: | https://doi.org/10.1097/EJA.0000000000000992 |
Publication type: | Article / Letter to editor |
Please use this identifier to cite or link to this item : https://hdl.handle.net/2066/215207 ![]() |
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Subject: | Radboudumc 0: Other Research RIHS: Radboud Institute for Health Sciences Radboudumc 10: Reconstructive and regenerative medicine RIHS: Radboud Institute for Health Sciences Radboudumc 11: Renal disorders RIHS: Radboud Institute for Health Sciences Radboudumc 14: Tumours of the digestive tract RIHS: Radboud Institute for Health Sciences Radboudumc 15: Urological cancers RIHS: Radboud Institute for Health Sciences Radboudumc 16: Vascular damage RIHS: Radboud Institute for Health Sciences Radboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences Radboudumc 2: Cancer development and immune defence RIMLS: Radboud Institute for Molecular Life Sciences Tijdelijke code tbv inlezen publicaties Radboudumc - Alleen voor gebruik door Radboudumc |
Organization: | Surgery Anesthesiology Urology Intensive Care Health Evidence Nephrology |
Journal title: |
European Journal of Anaesthesiology
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Volume: | vol. 36 |
Issue: | iss. 7 |
Page start: | p. 494 |
Page end: | p. 501 |
Abstract: |
BACKGROUND: Profound neuromuscular blockade (NMB) during anaesthesia has been shown to reduce postoperative pain scores, when compared with a moderate block. We hypothesised that profound NMB during laparoscopic donor nephrectomy (LDN) could also improve the early quality of recovery after surgery. OBJECTIVES: To compare the effectiveness of profound versus moderate NMB during LDN in enhancing postoperative recovery. DESIGN: A phase IV, double-blinded, randomised controlled trial. SETTING: Multicentre trial, from November 2016 to December 2017. PATIENTS: A total of 101 living kidney donors scheduled for LDN were enrolled, and 96 patients were included in the analyses. INTERVENTIONS: Patients were randomised to receive profound (posttetanic count 1 to 3) or moderate (train-of-four count 1 to 3) neuromuscular block. MAIN OUTCOME MEASURES: The primary outcome was the early quality of recovery at postoperative day 1, measured by the Quality of Recovery-40 Questionnaire. Secondary outcomes were adverse events, postoperative pain, analgesic consumption and length-of-stay. RESULTS: The intention-to-treat analysis did not show a difference with regard to the quality of recovery, pain scores, analgesic consumption and length-of-stay. Less intra-operative adverse events occurred in patients allocated to profound NMB (1/48 versus 6/48). Five patients allocated to a profound NMB received a moderate block and in two patients neuromuscular monitoring failed. The as-treated analysis revealed that pain scores were significantly lower at 6, 24 and 48 h after surgery. Moreover, the quality of recovery was significantly better at postoperative day 2 in patients receiving a profound versus moderate block (179.5 +/- 13.6 versus 172.3 +/- 19.2). CONCLUSION: Secondary analysis indicates that an adequately maintained profound neuromuscular block improves postoperative pain scores and quality of recovery. As the intention-to-treat analysis did not reveal a difference regarding the primary endpoint, future studies should pursue whether a thoroughly maintained profound NMB during laparoscopy improves relevant patient outcomes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02838134.
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