Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial.

BACKGROUND: In recent years, the relationship between the advantages and disadvantages of a deep neuromuscular block (DNMB), compared to a moderate block (MNMB) in laparoscopic surgery, has been increasingly studied. OBJECTIVE: Evaluate the effect of D-NMB compared to M-NMB in gynecological laparoscopic surgery. METHODS: This was a parallel-group, double-blind, randomized clinical trial, conducted at a single center in Italy between February 2020 and July 2020. American Society of Anesthesiologist (ASA) I-II risk class patients scheduled for elective gynecological laparoscopic surgery were randomized into a 1:1 ratio to either experimental or control group. The first one included DNMB with a rocuronium bolus at the starting dose of 1.2 mg/kg and a maintenance dose (0.3-0.6 mg/kg/h). The second one included MNMB with a rocuronium bolus at the starting dose of 0.6 mg/kg, and a maintenance dose in boluses (0.15-0.25 mg/kg). The primary outcome was the intraoperative surgical condition assessed every 15 min by the surgeon as a 5-point scale. The secondary outcome was the time needed to discharge patients from post-anesthesia care unit (PACU). The tertiary outcome was the assessment of the intra-operative hemodynamic instability. A sample size of 50 patients was planned. RESULTS: One hundred five patients were assessed for eligibility, 55 were excluded. Fifty patients met the inclusion criteria and were enrolled. The average score for the operative field was 4 for the D-NMB group and 3 for the M-NMB group (p value < 0.01). The length of stay in PACU was 13 min for the DNMB group and 22 min for the MNMB group (p value = 0.02). CONCLUSIONS: Deep neuromuscular block improves intraoperative surgical condition during gynecological laparoscopic surgery. TRIAL REGISTRATION: clinicalTrials.gov NCT03441828.

Low-dose spinal and opioid-free anesthesia in patient with Severe Aortic Stenosis and SARS-CoV-2 infection: Case report.

The best anesthesiologic approach to severe AS patient has not been adequately studied in literature. Although the current guidelines have a cautious attitude in this regard, Combined Spinal-Epidural Anesthesia (CSEA) has proved to be a safe technique. Therefore, we would like to provide our experience with a severe AS and COVID-19 patient.

Erector spinae plane block in laparoscopic nephrectomy as a cause of involuntary hemodynamic instability: A case report.

The Ultrasound-guided erector spinae plane block (US-ESPB), used as an anesthesiological block for opioid-sparing approach and for postoperative analgesia, could represent an involuntary cause of hemodynamic instability. This hemodynamic instability is accentuated by a greater diffusion of local anesthetic in the epidural space.

Opioid-free anesthesia-dexmedetomidine as adjuvant in erector spinae plane block: a case series.

BACKGROUND: Laparoscopic pain is related to the stretching of the peritoneum and peritoneal irritation caused by insufflation of the parietal peritoneum with carbon dioxide. In 2017, erector spinae plane block (ESPB) was described for management of postoperative pain following open and laparoscopic abdominal surgery. The use of multimodal anesthesia reduces both intraoperative and postoperative opioid use and improves analgesia. The addition of dexmedetomidine to the anesthetic mixture significantly prolongs analgesia, without clinically significant side effects. CASE PRESENTATION: We describe a series of three Caucasian women cases that illustrate the efficacy of bilateral ESPB performed at the level of the T7 transverse process to provide intraoperative and postoperative analgesia for laparoscopic gynecological surgery. CONCLUSION: Further investigation is recommended to establish the potential for ESPB with dexmedetomidine as adjuvant as an opioid-free anesthetic modality in laparoscopic gynecological surgery.

Ultrasound-guided Erector Spinae Plane Block (US-ESPB)-Anesthetic block: Case report.

The Ultrasound-guided Erector Spinae Plane Block (US-ESPB), used as an anesthesiological block, could represent a safe and effective alternative for thoracic wall surgery especially in fragile, obese patients and those with respiratory and/or hemodynamic problems.