Efficacy of profound versus moderate neuromuscular blockade in enhancing postoperative recovery after laparoscopic donor nephrectomy: A randomised controlled trial

Moira H D Bruintjes, Piet Krijtenburg, Chris H Martini, Paul P Poyck, Frank C H d'Ancona, Volkert A L Huurman, Michel van der Jagt, Johan F Langenhuijsen, Willemijn N Nijboer, Cornelis J H M van Laarhoven, Albert Dahan, Michiel C Warlé, RELAX collaborator group, Moira H D Bruintjes, Piet Krijtenburg, Chris H Martini, Paul P Poyck, Frank C H d'Ancona, Volkert A L Huurman, Michel van der Jagt, Johan F Langenhuijsen, Willemijn N Nijboer, Cornelis J H M van Laarhoven, Albert Dahan, Michiel C Warlé, RELAX collaborator group

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.

Figures

Fig. 1
Fig. 1
Consort flow diagram of patient enrolment.

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