Transplant Trial Watch

Deep neuromuscular blockade improves surgical conditions during low-pressure pneumoperitoneum laparoscopic donor nephrectomy.

Ozdemir-van Brunschot DMD, Braat AE, et al.

Surgical Endoscopy 2017; 22: 22.


Aims
To investigate whether deep neuromuscular blockade (NMB) improves surgical conditions during low-pressure pneumoperitoneum (PNP) laparoscopic donor nephrectomy (LDN).

Interventions
Participants were randomly assigned to either low-pressure PNP (6 mmHg) and deep NMB (Post-tetanic count 1–5), or low-pressure PNP (6 mmHg) and normal NMB (Train-of-four 0–1).

Participants
34 adult kidney donors scheduled for LDN.

Outcomes
The primary outcome measured was the mean peroperative surgical rating scale, measured after trocar introduction and every 15 minutes thereafter. Secondary outcome measures included operation time, abdominal pressure, need to increase intra-abdominal pressure, first warm ischemia time, estimated blood loss, perioperative complications, postoperative pain scores, postoperative complications, and postoperative serum creatinine levels.

Follow-up
48 hours after surgery

CET Conclusions
This small, blinded RCT from Leiden investigates the role of deep neuromuscular blockade during low-pressure pneumoperitoneum laparoscopic donor nephrectomy. Low-pressure pneumoperitoneum (6mmHg) has previously been shown to reduce post-operative pain, but sometimes hampers visibility and surgical access. Use of deep blockade may aid visibility during surgery making procedures safer. In this study, the authors demonstrate an improvement in surgical conditions with deep NMB, and lower post-operative opiate use. Insufflation pressures were numerically lower in the deep NMB group. These are interesting data and certainly worthy of further investigation in larger studies. It should be noted that there were 2 conversions to open in 19 patients in the moderate NMB group, and 4 major complications (bleeding, transection of the ureter). One must question, therefore, whether it is safe to practice low pressure pneumoperitoneum donor nephrectomy with standard NMB.

Jadad score
3

Data analysis
Strict intention-to-treat analysis

Alocation concealment
Yes

Trial registration
Clinicaltrials.gov - NCT02602964

Funding source
Not reported