BACKGROUND For some laparoscopic procedures, deep neuromuscular block has been shown to facilitate lower insufflation pressures and lower patient pain scores, and enhance postoperative recovery. We investigated the impact of deep neuromuscular block and its reversal on postoperative shoulder pain and outcomes after robotic prostate surgery. METHODS Elderly men undergoing robotic prostatectomy were randomised to deep neuromuscular block (target post-tetanic twitch of 1-2 at the facial nerve) with sugammadex reversal or moderate neuromuscular block (target 1-2 train-of-four ratio) with neostigmine reversal. The primary endpoint was postoperative shoulder pain. The secondary endpoints included intraoperative insufflation pressure, surgical rating score, incidence of residual neuromuscular block, and postoperative recovery. RESULTS A total of 50 subjects for each treatment arm were included in the analysis. The degree of neuromuscular block had no effect on the incidence of shoulder pain (deep block group 12% vs moderate block group 10%; P=1.0) or average insufflation pressure (median [inter-quartile range]) (13.3 [12.5-13.6] mm Hg vs 13.3 [11.7-14] mm Hg, P=0.86). After surgery, the deep block group had a higher normalised train-of-four ratio (0.98 [0.79-1.11] vs 0.85 [0.74-1.00]; P=0.008). The presence of postoperative shoulder pain was associated with higher BMI (31.8 [28-33.9] kg m-2vs 28 [24.8-31.1] kg m-2; P=0.036) and longer insufflation time (186 [156-257] min vs 154 [126-198] min; P=0.028). CONCLUSIONS The use of deep neuromuscular block during surgery does not decrease postoperative shoulder pain or enhance recovery after robotic prostatectomy. CLINICAL TRIAL REGISTRATION NCT03210376.

中文翻译：

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新斯的明逆转舒加葡糖或中度阻滞深部神经肌肉阻滞对机器人前列腺切除术老年患者肩痛的影响。

背景技术对于一些腹腔镜手术，已经显示出深层神经肌肉阻滞促进较低的吹入压力和较低的患者疼痛评分，并增强术后恢复。我们调查了深部神经肌肉阻滞及其逆转对机器人前列腺手术后术后肩部疼痛和预后的影响。方法将接受机器人前列腺切除术的老年男性随机分为深神经肌肉阻滞（在面部神经上发生强直性抽搐，目标为1-2），舒马葡糖逆转或中度神经肌肉阻滞（目标为1-2，四分之四），与新斯的明逆转。主要终点是术后肩痛。次要终点包括术中吹入压力，手术评分，残余神经肌肉阻滞的发生率和术后恢复。结果分析中每个治疗组总共有50名受试者。神经肌肉阻滞的程度对肩痛的发生率没有影响（深部阻滞组为12％，中度阻滞组为10％； P = 1.0）或平均吹入压力（中位[四分位数间距]）（13.3 [12.5-13.6] ] mm Hg对13.3 [11.7-14] mm Hg，P = 0.86）。手术后，深层阻滞组的标准化四列比率更高（0.98 [0.79-1.11]对0.85 [0.74-1.00]； P = 0.008）。术后肩痛的存在与较高的BMI（31.8 [28-33.9] kg m-2 vs 28 [24.8-31.1] kg m-2; P = 0.036）和较长的吹入时间（186 [156-257] min vs 154 [126-198]分钟； P ＝ 0.028）。结论手术过程中使用深层神经肌肉阻滞术并不能减轻术后肩部疼痛或提高机器人前列腺切除术后的恢复能力。