دورية أكاديمية
Efficacy of profound versus moderate neuromuscular blockade in enhancing postoperative recovery after laparoscopic donor nephrectomy: A randomised controlled trial.
| العنوان: | Efficacy of profound versus moderate neuromuscular blockade in enhancing postoperative recovery after laparoscopic donor nephrectomy: A randomised controlled trial. |
|---|---|
| المؤلفون: | Bruintjes MHD, Krijtenburg P, Martini CH, Poyck PP, d'Ancona FCH, Huurman VAL, van der Jagt M, Langenhuijsen JF, Nijboer WN, van Laarhoven CJHM, Dahan A, Warlé MC |
| مؤلفون مشاركون: | RELAX collaborator group |
| المصدر: | European journal of anaesthesiology [Eur J Anaesthesiol] 2019 Jul; Vol. 36 (7), pp. 494-501. |
| نوع المنشور: | Clinical Trial, Phase IV; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins, 2009- Country of Publication: England NLM ID: 8411711 Publication Model: Print Cited Medium: Internet ISSN: 1365-2346 (Electronic) Linking ISSN: 02650215 NLM ISO Abbreviation: Eur J Anaesthesiol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Cambridge : Lippincott Williams & Wilkins, 2009- Original Publication: Oxford ; Boston : Published on behalf of the European Academy of Anaesthesiology by Blackwell Scientific, 1984-2004 |
| مواضيع طبية MeSH: | Laparoscopy/*methods , Nephrectomy/*methods , Neuromuscular Blockade/*methods , Tissue and Organ Harvesting/*methods, Aged ; Double-Blind Method ; Female ; Humans ; Living Donors ; Male ; Middle Aged ; Neuromuscular Monitoring/methods ; Pain, Postoperative/epidemiology ; Postoperative Period |
| مستخلص: | 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. |
| References: | Acta Anaesthesiol Scand. 2019 Mar;63(3):306-313. (PMID: 30324626) Anesthesiology. 2003 May;98(5):1042-8. (PMID: 12717123) Anesth Analg. 2019 Jun;128(6):1361-1363. (PMID: 31094813) Trials. 2017 Mar 4;18(1):99. (PMID: 28259181) Br J Anaesth. 2000 Jan;84(1):11-5. (PMID: 10740540) Br J Anaesth. 2017 Jun 1;118(6):834-842. (PMID: 28575335) Trials. 2015 Aug 12;16:345. (PMID: 26265279) Clin Transplant. 2013 Jul-Aug;27(4):E478-83. (PMID: 23795745) Ann Surg. 2004 Aug;240(2):205-13. (PMID: 15273542) Can J Anaesth. 1998 Jun;45(6):526-32. (PMID: 9669005) Eur J Anaesthesiol. 2016 May;33(5):341-7. (PMID: 26479510) Medicine (Baltimore). 2016 Mar;95(9):e2920. (PMID: 26945393) Br J Anaesth. 2014 Mar;112(3):498-505. (PMID: 24240315) Eur Urol Focus. 2018 Jul;4(4):608-613. (PMID: 28753862) World J Surg. 2017 Nov;41(11):2950-2958. (PMID: 28608013) Anaesthesia. 2018 Sep;73(9):1090-1096. (PMID: 29727028) World J Surg. 2016 Dec;40(12):2898-2903. (PMID: 27405749) PLoS One. 2015 Aug 28;10(8):e0135412. (PMID: 26317357) PLoS One. 2016 Dec 9;11(12):e0167907. (PMID: 27936214) Anesth Analg. 2015 Jan;120(1):51-8. (PMID: 25625254) Br J Anaesth. 2017 Sep 1;119(3):435-442. (PMID: 28969327) |
| سلسلة جزيئية: | ClinicalTrials.gov NCT02838134 |
| تواريخ الأحداث: | Date Created: 20190329 Date Completed: 20200612 Latest Revision: 20200612 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC6613722 |
| DOI: | 10.1097/EJA.0000000000000992 |
| PMID: | 30920983 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1365-2346 |
|---|---|
| DOI: | 10.1097/EJA.0000000000000992 |