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Effects of neuromuscular blockade on the surgical conditions of laparoscopic totally extraperitoneal inguinal hernia repair: a randomized clinical trial

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Abstract

Purpose

Unlike other laparoscopic techniques, the peritoneum is not incised in laparoscopic totally extraperitoneal inguinal hernia repair (TEP), and the preperitoneal space is developed as the surgical field by blunt dissection and CO2 insufflation. While many studies have investigated the effect of neuromuscular blockade (NMB) on the surgical conditions and postoperative pain of laparoscopic intraperitoneal surgery, few studies have investigated those of TEP. In the present study, we investigated the effect of NMB on the surgical conditions and postoperative pain of TEP.

Methods

Forty-two adult patients scheduled for unilateral TEP under general anesthesia with remifentanil and desflurane were randomly assigned to paralyzed or non-paralyzed groups. In the paralyzed group, rocuronium doses were administered to maintain post-tetanic count at ≤ 5 during surgery. Non-paralyzed subjects were not given any rocuronium. Postoperatively, surgeon-evaluated surgical conditions, assessed using a 100-mm visual analogue scale ranging from 0 mm (not acceptable) to 100 mm (excellent), were compared between the two groups. For evaluation of postoperative pain, the time from the end of anesthesia to the initial requirement of postoperative analgesia was compared by the log-rank test.

Results

Median [interquartile range] score of surgical condition in the paralyzed and non-paralyzed groups were 84 [75–90] and 84 [78–87], respectively (P = 0.46). Significant differences in postoperative analgesic requirements between the two groups were not confirmed (P = 0.74).

Conclusion

NMB did not improve the surgical conditions nor reduce postoperative pain. NMB is not routinely needed for TEP just because it is a laparoscopic procedure.

Clinical trial registration

The trial was registered in the UMIN clinical trials registry (UMIN000029683, October 24, 2017; Principal investigator: Masafumi Fujimoto, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000033920) prior to patient enrolment.

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Data availability

Available from the corresponding author on reasonable request.

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Acknowledgements

We thank Hiroshi Kaneda, M.D., Shigeki Okamura, M.D., Kazuki Hori, M.D., Toshiyuki Okuma, M.D. and Hidetaka Sugihara, M.D., the surgeons of Nishinihon Hospital for their help in performing the study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Anesthesiology, Nishinihon Hospital, 3-20-1, Hattannda, Higashiku, Kumamoto, Kumamoto, 861-8034, Japan

    M. Fujimoto & F. Kubota

  2. Department of Surgery, Nishinihon Hospital, 3-20-1, HattanndaKumamoto, HigashikuKumamoto, 861-8034, Japan

    H. Kaneda

Authors
  1. M. Fujimoto
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  2. F. Kubota
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  3. H. Kaneda
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Masafumi Fujimoto, Fumiyo Kubota and Hiroshi Kaneda. The first draft of the manuscript was written by Masafumi Fujimoto and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to M. Fujimoto.

Ethics declarations

Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Masafumi Fujimoto, Fumiyo Kubota and Hiroshi Kaneda declare that they have no conflict of interest.

Ethics approval

This prospective randomized clinical trial was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The trial was approved by the ethics committee of Nishinihon Hospital, Kumamoto, Japan (protocol H29-4; October 31, 2017; Chairperson: Toshiyuki Arima).

Consent to participate

Prior written informed consent was obtained from all subjects participating in the trial.

Consent to publish

Patients signed informed consent regarding publishing their data.

Ethical standards

This clinical trial complies with the current laws of Japan.

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Fujimoto, M., Kubota, F. & Kaneda, H. Effects of neuromuscular blockade on the surgical conditions of laparoscopic totally extraperitoneal inguinal hernia repair: a randomized clinical trial. Hernia 26, 1179–1186 (2022). https://doi.org/10.1007/s10029-022-02570-5

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  • DOI: https://doi.org/10.1007/s10029-022-02570-5

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