title: Deep neuromuscular blockade leads to a larger intraabdominal volume during laparoscopy.
abstract: Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that lowering the insufflation pressure during surgery may reduce the risk of post-operative pain. In this pilot study, a method is presented for measuring the intra-abdominal space available to the surgeon during laproscopy, in order to examine whether the relaxation produced by deep neuromuscular blockade can increase the working surgical space sufficiently to permit a reduction in the CO2 insufflation pressure. Using the laproscopic grasper, the distance from the promontory to the skin is measured at two different insufflation pressures: 8 mm Hg and 12 mm Hg. After the initial measurements, a neuromuscular blocking agent (rocuronium) is administered to the patient and the intra-abdominal volume is measured again. Pilot data collected from 15 patients shows that the intra-abdominal space at 8 mm Hg with blockade is comparable to the intra-abdominal space measured at 12 mm Hg without blockade. The impact of neuromuscular blockade was not correlated with patient height, weight, BMI, and age. Thus, using neuromuscular blockade to maintain a steady volume while reducing insufflation pressure may produce improved patient outcomes.
authors.affiliation: Department of Anesthesiology, Aleris-Hamlet Hospitals, Soeborg, Denmark. astrid.lindekaer@aleris-hamlet.dk
authors.forename: Astrid Listov
authors.initials: AL
authors.lastname: Lindekaer
authors.forename: Henrik
authors.initials: H
authors.lastname: Halvor Springborg
authors.forename: Olav
authors.initials: O
authors.lastname: Istre
mesh_terms: D034841:Abdominal Cavity / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D019148:Neuromuscular Blockade / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D010865:Pilot Projects; D063186:Uterine Myomectomy / Q000009:adverse effects / Q000379:methods