Does deep neuromuscular blockade during laparoscopy procedures change patient, surgical, and healthcare resource outcomes? A systematic review and meta-analysis of randomized controlled trials.

Autor: Raval AD; Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, United States of America., Deshpande S; Evidence, Modeling, and Synthesis, Evidera Inc., London, England, United Kingdom., Rabar S; Evidence, Modeling, and Synthesis, Evidera Inc., London, England, United Kingdom., Koufopoulou M; Evidence, Modeling, and Synthesis, Evidera Inc., London, England, United Kingdom., Neupane B; Evidence, Modeling, and Synthesis, Evidera Inc., London, England, United Kingdom., Iheanacho I; Evidence, Modeling, and Synthesis, Evidera Inc., London, England, United Kingdom., Bash LD; Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, United States of America., Horrow J; Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, United States of America., Fuchs-Buder T; Department of Anesthesiology & Critical Care, Brabois University Hospital, University de Lorraine, CHRU Nancy, Vandoeuvre-les-Nancy, France.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2020 Apr 16; Vol. 15 (4), pp. e0231452. Date of Electronic Publication: 2020 Apr 16 (Print Publication: 2020).
DOI: 10.1371/journal.pone.0231452
Abstrakt: Background: Deep neuromuscular blockade may facilitate the use of reduced insufflation pressure without compromising the surgical field of vision. The current evidence, which suggests improved surgical conditions compared with other levels of block during laparoscopic surgery, features significant heterogeneity. We examined surgical patient- and healthcare resource use-related outcomes of deep neuromuscular blockade compared with moderate neuromuscular blockade in adults undergoing laparoscopic surgery.
Methods: We conducted a systematic literature review according to the quality standards recommended by the Cochrane Handbook for Systematic Reviews. Randomized controlled trials comparing outcomes of deep neuromuscular blockade and moderate neuromuscular blockade among adults undergoing laparoscopic surgeries were included. A random-effects model was used to conduct pair-wise meta-analyses.
Results: The systematic literature review included 15 studies-only 13 were analyzable in the meta-analysis and none were judged to be at high risk of bias. Compared with moderate neuromuscular blockade, deep neuromuscular blockade was associated with improved surgical field of vision and higher vision quality scores. Also, deep neuromuscular blockade was associated with a reduction in the post-operative pain scores in the post-anesthesia care unit compared with moderate neuromuscular blockade, and there was no need for an increase in intra-abdominal pressure during the surgical procedures. There were minor savings on resource utilization, but no differences were seen in recovery in the post-anesthesia care unit or overall length of hospital stay with deep neuromuscular blockade.
Conclusions: Deep neuromuscular blockade may aid the patient and physician surgical experience by improving certain patient outcomes, such as post-operative pain and improved surgical ratings, compared with moderate neuromuscular blockade. Heterogeneity in the pooled estimates suggests the need for better designed randomized controlled trials.
Competing Interests: SD, MK, II, SR, CPF, and DLA are employees of Evidera, which provides consulting and other research services to biopharmaceutical companies. ADR, JH, and LDB are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. TFB has received honoraria for lectures from Merck. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Databáze: MEDLINE
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