Evidence for the need of a deep neuromuscular block during laparoscopic surgery?

Since sugammadex has been available, maintaining a continuous deep neuromuscular block (cDNMB) from tracheal intubation until closure of the fascia during laparoscopic surgery is no longer incompatible with a fast recovery. In this review, studies comparing cDNMB [0 train-of-four (TOF) counts, 1-2 post-tetanic counts] and continuous moderate neuromuscular block (cMNMB) (1-3 TOF counts) are analyzed. In 9 available studies for laparoscopy, the authors concluded that cDNMB provides superior surgical working conditions, with lower insufllation pressures, and, therefore, less pain. Regrettably for anesthesiologists, the main focus of those studies was the surgical working conditions (evaluated using a non-validated scale), with less emphasis on patient-related outcomes. Moreover, the control group often had very light block. Due to these problems, we suggest that there is not much evidence supporting the routine use of cDNMB at the moment. This does not mean that cDNMB could not have some advantages.