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conferenceseries.com
Volume 6, Issue 5 (Suppl) J Pain Relief, an open access journal
ISSN: 2167-0846 Pain Management 2017
October 05-06, 2017
5th International Conference and Exhibition on
October 05-06, 2017 London, UK
Pain Research And Management
Effect of depth of neuromuscular block on intraoperative surgical conditions and pain in morbidly
obese patients undergoing laparoscopic bariatric surgery:Adouble blind randomized controlled trial
Bart Torensma1,2, Martini C, Boon M, In 't Veld B, Liem R, Knook M, Swank D J and Dahan A
1Leiden University Medical Center, Netherlands
2Dutch Obesity Clinic West, Netherlands
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.
Methods & Results: 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 post anesthesia-
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 favored 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.
Biography
Bart Torensma (MSc) has his experience in the field of Epidemiology and Anesthesiology. As CRNA he developed, in the last 10 years, the fast track bariatric
surgery for the Dutch Obesity Clinics in the Netherlands. As PhD candidate at the University of Leiden (LUMC) he is doing research in the subjects with obesity
combining this with the research in the operation theatre during surgery. Deep neuromuscular blockage and the finding of reducing pain post-operative with lower
opiate consumption is one of his research projects. Furthermore, he developed his own masterclass in Epidemiology, Anesthesiology and Physiological effects of
stress in the brain and the effect on the human behavior.
Bart Torensma et al., J Pain Relief 2017, 6:5(Suppl)
DOI: 10.4172/2167-0846-C1-014