• Chung-Sik Oh, Ho Yung Lim, Hong Jun Jeon, Tae-Hoon Kim, Hyun-Jun Park, Liyun Piao, and Seong-Hyop Kim.
• From the Department of Anaesthesiology and Pain Medicine (C-SO, HYL, S-HK), Department of Psychiatry (HJJ), Department of Orthopaedic surgery, Konkuk University Medical Centre (T-HK), Department of Infection and Immunology (H-JP, LP, S-HK), Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Korea (C-SO, S-HK).
• Eur J Anaesthesiol. 2021 Mar 1; 38 (Suppl 1): S58-S66.

BackgroundDeep neuromuscular blockade (NMB) may reduce muscle injury and related inflammation. The inflammation is one of the pathophysiological processes of peri-operative complications.ObjectiveTo compare the degree of inflammation and related postoperative complications including postoperative delirium (POD) and peri-operative bleeding according to the degree of NMB during general anaesthesia for total hip replacement.DesignA prospective, single-blind, randomised controlled trial.SettingTertiary, university hospital, single centre.PatientsEighty-two patients undergoing total hip replacement surgery were included in the final analysis.InterventionsModerate (Mod) and deep (Deep) NMB groups.Main Outcome MeasuresThe changes in inflammatory cytokines were measured. The incidence of POD was evaluated by using confusion assessment method (CAM). The differences of postoperative bleeding and peri-operative oxygenation in both groups were also measured.ResultsThe NMB reversal duration was significantly longer in the Mod NMB group than in the Deep NMB group. Changes in interleukin-6 were significantly smaller in the Deep NMB group than in the Mod NMB group (P < 0.001). The incidence of POD was not significantly different between groups (34 versus 17% in Mod and Deep NMB groups, respectively; P = 0.129). The amount of postoperative bleeding until postoperative day 2 was significantly greater in the Mod NMB group than in the Deep NMB group (P = 0.027).ConclusionOur findings suggest that inflammation related to peri-operative complications could be associated with the depth of NMB during total hip replacement. However, the incidence of POD might not be associated to the depth of NMB.Trial RegistrationNational Library of Medicine (NLM) at the National Institutes of Health (NIH) of United States. (Identifier: NCT02507609). Online address: http://clinicaltrials.gov.Copyright © 2020 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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