TOPLINE

Patients who received deep neuromuscular blockade (NMB) during posterior lumbar interbody fusion had a lower incidence of chronic postsurgical pain at 3 months than those who received moderate NMB. Patients who received deep NMB also had lower pain scores, reduced opioid consumption, and higher quality-of-recovery scores after surgery.

METHODOLOGY

• Researchers conducted a randomized clinical trial at a center in China to assess the efficacy of deep NMB for the reduction of chronic postsurgical pain among adults scheduled for elective posterior lumbar interbody fusion.
• Patients with American Society of Anesthesiologists physical status I-III (mean age, 59.5 years; 38.8% men) were randomly assigned to receive either deep NMB (a persistent train-of-four [TOF] count of 0 and a posttetanic count of 1-2; n = 89) or moderate NMB (a TOF count of 1-2; n = 89); both levels of NMB were maintained with continuous rocuronium infusion during surgery.
• The primary endpoint was the incidence of chronic postsurgical pain assessed at 3 months; chronic postsurgical pain was defined as an increase in pain or the development of pain in the surgical area that persisted beyond 3 months, excluding pain due to other causes such as infection or malignancy.
• Additional outcomes included how satisfied the surgeons were; the incidence of rescue analgesia, severe hypoxemia, and delay in emergence in the postanesthesia care unit; quality-of-recovery scores 3 days after the operation; opioid consumption after surgery; how many patients had chronic pain after surgery at the 6-month mark; and other outcomes.

TAKEAWAY

• At 3 months, the incidence of chronic postsurgical pain was lower in the deep NMB group than in the moderate NMB group (19.1% vs 34.8%; risk ratio [RR], 0.6; 95% CI, 0.3-0.9). At 6 months, the incidence did not differ significantly between the groups.
• Patients in the deep NMB group had consistently lower pain scores over the period from 2 hours to 6 months post-surgery (P < .05 for all), required less rescue analgesia in the postanesthesia care unit (RR, 0.2; P = .003), and used fewer opioids overall after surgery (median difference, -25.0 mg morphine equivalents; P < .001). 
• Within 6 months, the incidence of hospital revisits related to pain was lower in the deep NMB group (RR, 0.5; P = .025). On postoperative day 1, serum levels of creatine kinase, myoglobin, and lactate dehydrogenase were lower in the deep NMB group (P < .001 for all).
• Surgeon-reported satisfaction scores during surgery were higher in the deep NMB group (P < .001) and so were quality-of-recovery scores at 3 days, 3 months, and 6 months after surgery (P < .05 for all). Although no significant differences in overall adverse event rates were observed between groups, the time to extubation was longer in the deep NMB group (mean difference, 3.7 minutes; P = .002).

IN PRACTICE

"[The] findings suggest that minimizing initial surgical muscle trauma and its associated early pain burden may be an effective strategy to reduce CPSP [chronic postsurgical pain] in selected patients undergoing elective degenerative posterior lumbar interbody fusion," the researchers wrote. "DNMB [deep NMB] should be used selectively according to procedural neurological risk, the anticipated need for functional neuromonitoring, institutional resources, and an individualized assessment by the spine surgeon and anesthesiologist," they added.

SOURCE

The study was led by Xinghe Wang, MD, Jing Xia, MD, and Dong Huang, MD, of the Affiliated Hospital of Xuzhou Medical University, in Xuzhou, China. It was published online on October 07 in Anesthesia & Analgesia.

LIMITATIONS

Untracked pain medication use throughout the 6-month observation period may have masked differences in the incidence of chronic pain. The study may have lacked adequate statistical power for identifying modest effects.

DISCLOSURES

This study was supported by grants from the Natural Science Research Fund of Higher Education Institutions in Jiangsu Province, the Science and Technology Project of Xuzhou Health Commission, the Construction Project of High Level Hospital of Jiangsu Province, and the Paired Assistance Scientific Research Project by The Affiliated Hospital of Xuzhou Medical University. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.