• Moira H D Bruintjes, Piet Krijtenburg, Chris H Martini, Paul P Poyck, d'Ancona Frank C H FCH, Volkert A L Huurman, Michel van der Jagt, Johan F Langenhuijsen, Willemijn N Nijboer, van Laarhoven Cornelis J H M CJHM, Albert Dahan, Michiel C Warlé, and RELAX collaborator group.
• Eur J Anaesthesiol. 2019 Jul 1; 36 (7): 494-501.

BackgroundProfound 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.ObjectivesTo compare the effectiveness of profound versus moderate NMB during LDN in enhancing postoperative recovery.DesignA phase IV, double-blinded, randomised controlled trial.SettingMulticentre trial, from November 2016 to December 2017.PatientsA total of 101 living kidney donors scheduled for LDN were enrolled, and 96 patients were included in the analyses.InterventionsPatients were randomised to receive profound (posttetanic count 1 to 3) or moderate (train-of-four count 1 to 3) neuromuscular block.Main Outcome MeasuresThe 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.ResultsThe 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).ConclusionSecondary 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 RegistrationClinicalTrials.gov identifier: NCT02838134.

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