Deep versus Moderate Neuromuscular Blockade During Total Hip Replacement Surgery on Postoperative Recovery and Immune Function: A Randomized Controlled Trial.

Abstract

BACKGROUND Deep neuromuscular blockade (NMB) enhances surgical working conditions in laparoscopic surgery. Whether this accounts for nonlaparoscopic surgery is not known. Additionally, the effect on clinical and patient-reported outcomes remains debated. In this study, the effect of deep NMB compared to moderate NMB during total hip arthroplasty (THA) on quality of recovery and postoperative inflammation is investigated. METHODS This single-center randomized controlled blinded trial comprised 100 patients undergoing THA treated with deep NMB (posttetanic count 1-2) or moderate NMB (train-of-four 1-2). Continuous or bolus administration of rocuronium was used. The primary end point was quality of recovery on postoperative day 1 (POD1), measured by the Quality of Recovery-40 (QoR-40) questionnaire. The secondary end points were innate immune function and pain scores on POD1, measured by ex vivo production capacity of tumor necrosis factor (TNF) and interleukin (IL)-1β on whole blood stimulation with lipopolysaccharide and postoperative pain as rated by the numeric rating scale. RESULTS There was no difference in QoR-40 score on POD1 (mean difference -4.1, 95% confidence interval -10.9 to 2.8, P = .241). On POD 1, there was no difference in ex vivo production capacity of TNF (moderate NMB median [quartiles] 890 [532-1605] pg/mL, deep NMB 1113 [651-1716] pg/mL, P = .34, Mann-Whitney U test, median difference -125, 95% confidence interval [CI], -440 to 155) and IL-1β (moderate NMB 1148 [545-1970] pg/mL, deep NMB median 1386 [826-1940] pg/mL, P = .36, median difference [MD] -135, 95% CI, -470 to 191) on lipopolysaccharide stimulation. On POD1, there was no statistically significant difference in pain scores at rest (MD 1.10, 99.6% CI, -0.53 to 2.74, P = .049) and on movement (MD 0.94, 99.6% CI, -0.63 to 2.50, P = .080). CONCLUSIONS No evidence was found for a beneficial effect of deep NMB compared to moderate NMB in THA regarding quality of recovery or postoperative inflammation.