title: Deep Neuromuscular Block Improves Surgical Conditions during Bariatric Surgery and Reduces Postoperative Pain: A Randomized Double Blind Controlled Trial.
abstract: BACKGROUND
  It remains unknown whether the administration of a deep neuromuscular block (NMB) during bariatric surgery improves surgical conditions and patient outcome. The authors studied the effect of deep versus moderate NMB in laparoscopic bariatric surgery on surgical conditions and postoperative pain.
  
  
  RESULTS
  One hundred patients scheduled to undergo elective bariatric surgery were randomized to a deep NMB (post-tetanic-count 2-3) or a moderate NMB (train-of-four 1-2). The quality of the surgical field was scored using the Leiden-Surgical Rating Scale (L-SRS), a 5-point scale ranging from 1 (extremely poor conditions) to 5 (optimal conditions). Three surgeons scored the L-SRS at 10-min intervals during surgery; postoperative pain scores were obtained in the postanesthesia-care-unit (PACU) and on the ward. Mean (95% confidence interval) L-SRS scores in moderate NMB 4.2 (4.0-4.4) versus 4.8 (4.7-4.9) in deep NMB (p < 0.001). Moderate NMB resulted in 17% of scores at L-SRS scores of 1-3, while deep NMB resulted in 100% scores at the high end of the L-SRS (4-5). Deep NMB led to improved pain scores in the PACU (4.6 (4.2-4.9) versus 3.9 (3.6-4.4), p = 0.03) and reduced shoulder pain on the ward (1.8 (1.5-2.1) versus 1.3 (1.1-1.5), p = 0.03). A composite score of pain and opioid use in the PACU favoured deep NMB (p = 0.001).
  
  
  CONCLUSIONS
  In bariatric surgery, deep relaxation has advantages for surgeon and patient. Compared to moderate NMB, deep NMB produced stable and improved surgical conditions with less postoperative pain.
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.|Department of Surgery, Dutch Obesity Clinic West, The Hague, The Netherlands.|Department of Anesthesiology, Haaglanden Medical Center, The Hague, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Torensma
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Chris H
authors.initials: CH
authors.lastname: Martini
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: Boon
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Olofsen
authors.affiliation: Department of Anesthesiology, Haaglanden Medical Center, The Hague, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: In 't Veld
authors.affiliation: Department of Surgery, Dutch Obesity Clinic West, The Hague, The Netherlands.
authors.forename: Ronald S L
authors.initials: RS
authors.lastname: Liem
authors.affiliation: Department of Surgery, Dutch Obesity Clinic West, The Hague, The Netherlands.
authors.forename: Mireille T T
authors.initials: MT
authors.lastname: Knook
authors.affiliation: Department of Surgery, Dutch Obesity Clinic West, The Hague, The Netherlands.
authors.forename: Dingeman J
authors.initials: DJ
authors.lastname: Swank
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Dahan
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade; D010149:Postoperative Pain / Q000517:prevention & control*