Deep Neuromuscular Block Reduces Pain, Opioid Use in Spinal Surgery Patients

Compared with moderate neuromuscular block, deep neuromuscular block was associated with improved long-term quality of recovery and reduced chronic postsurgical pain.

Deep neuromuscular block (DNMB) reduced chronic postsurgical pain and postoperative opioid consumption while improving the long-term recovery of patients who had spinal surgery, according to results from a randomized, double-blind study published in Pain and Therapy.

Researchers identified 220 patients between May and November 2022 for inclusion in the study. The patients were randomly assigned to receive either DNMB (the D group, n=104) or moderate neuromuscular block (MNMB; the M group, n=105); 11 patients were lost to follow up.

The primary outcome was the incidence of chronic postsurgical pain, while secondary outcomes included visual analogue scale (VAS) scores in the post-anesthesia recovery unit (PACU) at 12, 24, 48 hours, and 3 months post-surgery; postoperative opioid consumption; and QoR-15 scores on the second postoperative day, before discharge, and 3 months post-surgery.

Patients in the D group had a lower incidence of chronic postsurgical pain at 28.85% compared with 42.86% in patients in the M group (P =.035). In addition, the VAS scores were significantly reduced in those in the D group in the third month (P =.016). In the PACU, and 12 hours after surgery, the VAS scores were also significantly lower in those in the D group than in the M group (P <.001, P =.004, respectively). Patients in the D group had significantly less postoperative opioid consumption than those in the M group (P =.027), expressed in total oral morphine equivalents. Finally, 3 months after surgery, the QoR-15 scores were significantly higher in patients in the D group than in the M group (P =.003).

[C]ompared with MNMB, DNMB significantly reduced CPSP and postoperative opioid consumption in spinal surgery patients.

Among several limitations, the researchers noted that the study population only included patients who underwent lumbar surgery. Patients who underwent cervical or thoracic surgery were excluded. Moreover, the interventions’ mechanisms and mediators were not the study’s focus.

 “In conclusion, compared with MNMB, DNMB significantly reduced [chronic postsurgical pain] and postoperative opioid consumption in spinal surgery patients. Moreover, DNMB improved the long-term recovery of patients,” the study authors concluded.

Disclosure: This research was supported by the Natural Science Research Fund of Higher Education Institutions in Jiangsu Province (22KJA320007). Please see the original reference for a full list of disclosures.

References:

Tang X, Wu Y, Chen Q, Xu Y, Wang X, Liu S. Deep Neuromuscular Block Attenuates Chronic Postsurgical Pain and Enhances Long-Term Postoperative Recovery After Spinal Surgery: A Randomized Controlled Trial. Pain Ther. Published online June 6, 2023. doi:10.1007/s40122-023-00528-8