Impact of the combination of abdominal peripheral nerve block and neuromuscular blockade on the surgical space during robot-assisted laparoscopic surgery: a prospective randomized controlled study

• Published in: Journal of anesthesia 2024-06, Vol.38 (3), p.321-329
• Main Authors: Noguchi, Satoko, Saito, Junichi, Nakai, Kishiko, Kitayama, Masato, Hirota, Kazuyoshi
• Format: Article
• Language: English
• Subjects: Anesthesiology; Critical Care Medicine; Emergency Medicine; Intensive; Medicine; Medicine & Public Health; Original Article; Pain Medicine
• ISSN: 0913-8668; 1438-8359; 1438-8359
• DOI: 10.1007/s00540-024-03309-5

Purpose The impact of the combination of abdominal peripheral nerve block (PNB) and the depth of neuromuscular blockade on the surgical field were assessed. Methods Thirty-eight patients undergoing elective robot-assisted laparoscopic radical prostatectomy (RARP) were randomized into two groups: a PNB group (moderate neuromuscular block [train-of-four 1–3 twitches] with abdominal PNB) and a non-PNB group (deep neuromuscular block [post-tetanic count 0–2 twitches] without abdominal PNB). The primary outcome was the change in the depth of the abdominal cavity relaxation assessed by the change in the distance ( Δdistance) between the umbilicus port and peritoneum upon pneumoperitoneal pressure increase from 8 to 12 mmHg. The secondary outcomes were the CO 2 usage for the pneumoperitoneal pressure increase and the subjective differences in the Surgical Rating Score (SRS) during surgery. Results The Δdistance and the CO 2 usage from 8 to 12 mmHg did not differ significantly between the non-PNB and PNB groups (1.34 ± 0.65 vs. 1.28 ± 0.61 cm, p = 0.763 and 3.64 ± 1.68 vs. 4.34 ± 1.44 L, p = 0.180, respectively). There was also no significant difference in SRS. Comparisons of the Δdistance values for pressure increases from 6 to 8 mmHg, 6 to 10 mmHg and 6 to 12 mmHg between the non-PNB and PNB groups also showed no between-group differences, despite significant intra-group differences (p