A randomized trial comparing deep and moderate neuromuscular blockade in patients undergoing ambulatory gynecologic laparoscopy

Background and aims Deep neuromuscular blockade (NMB) is known to improve surgical conditions, compared to moderate neuromuscular blockade (NMB), which is expected to improve postoperative quality of recovery (QOR). However, it is unknown whether deep NMB improves postoperative QOR in ambulatory gynecologic laparoscopy. Therefore, we compared the effects of deep and moderate NMB on postoperative QOR in ambulatory gynecologic laparoscopy. Methodology We included 80 female in this study. They were randomized into 2 equal groups: deep NMB (dNMB) and moderate NMB (mNMB) at constant pneumoperitoneum pressure of 12 mmHg. The primary outcome was QOR-40 at 24 h, and the secondary outcomes were duration of surgery, surgical rating scale (SRS) score, time to home discharge readiness, pain scores, and tramadol consumption. Results The SRS scores were significantly higher in dNMB group, compared with mNMB. Mean (95% CI) SRS scores in deep NMB were 4.55 (4.52-4.58) versus 4.15 (4.11-4.19) in moderate NMB,p= 0.03. However, there was no significant difference between the two groups in the QoR-40 scores, and other secondary outcomes. Conclusion We found no difference between deep and moderate NMB on postoperative QOR after ambulatory gynecologic laparoscopy. Therefore, deep NMB during ambulatory gynecologic laparoscopy may be unnecessary, at least in non-obese patients.