关键词: 持续深肌松, 常规肌松, 极度头低位, 术后肩痛, 机器人辅助腹腔镜手术

Abstract:

Objective To compare the impact of continuous profound neuromuscular blockade versus conventional neuromuscular blockade on postoperative shoulder pain in patients undergoing robot?assisted laparoscopic surgery during steep Trendelenburg position. Methods This study was a single?center， randomized， double?blind clinical trial. The inclusion criteria encompassed individuals aged between 18 and 80 years， with an American Society of Anesthesiologists status of Ⅰ or Ⅱ， and a body mass index ranging from 18 kg/m² to 30 kg/m². A total of one hundred patients were randomly assigned to either the deep neuromuscular blockade group （D group） or the conventional neuromuscular blockade group （C group）， with equal distribution of fifty cases in each group. Rocuronium dosage was titrated to achieve post?tetanic count values of 1 ~ 2 and train?of?four stimulation levels of 1 ~ 2 during surgery for D and C groups respectively. At the end of surgery， sugammadex was administered for reversal of neuromuscular blockade. The primary endpoint assessed the incidence of postoperative shoulder pain within three days after surgery. Secondary endpoints included Leiden score evaluation during intraoperative period， number of additional neuromuscular blockers required by the surgeon， recovery time for muscle relaxation postoperatively， nausea and vomiting scores during recovery phase， visual analog scale （VAS） scores in Post?Anesthesia Care Unit （PACU） as well as within three days after surgery， incidence rate for postoperative pulmonary complications， length of hospital stay duration and patient satisfaction score. Results The incidence of postoperative shoulder pain was significantly lower in group D compared to group C （D group 32% vs. C group 56%；P < 0.05）. However， there were no significant differences in postoperative shoulder pain VAS scores between the two groups （P > 0.05）. No significant differences were observed between the groups in terms of Leiden score， surgeon's requirement for additional neuromuscular blockers， nausea and vomiting in PACU， and VAS score （P > 0.05）. Group D exhibited better early postoperative activity pain scores than group C （P < 0.05）. There were no significant differences in VAS scores between the groups at other time points （P > 0.05）. Furthermore， there were no significant differences in the incidence of postoperative pulmonary complications， length of stay， and satisfaction scores between the two groups. Conclusion The implementation of continuous deep neuromuscular blockade in patients undergoing robot?assisted laparoscopic surgery with steep Trendelenburg position can effectively mitigate the occurrence of postoperative shoulder pain.

Key words: continue deep neuromuscular blockade, conventional neuromuscular blockade, steep trendelenburg position, postoperative shoulder pain, robotassisted laparoscopic surgery