What question did this study set out to answer?

This study aims to assess the effects of neuromuscular blockade depth on surgical conditions and postoperative outcomes during LESS surgery for total hysterectomy.

March 2, 2026Open Access

Deep neuromuscular blockade improves surgical conditions during laparoendoscopic single-site (LESS) surgery for total hysterectomy and reduces postoperative pain: a randomized controlled trial

Key Points

This study aims to assess the effects of neuromuscular blockade depth on surgical conditions and postoperative outcomes during LESS surgery for total hysterectomy.
243 female patients underwent randomized allocation to deep NMB or moderate NMB groups.
Continuous intravenous infusion of cisatracurium was administered during surgery.
Surgical Rating Scale scores served as a primary endpoint.
Postoperative outcomes included Visual Analog Scale scores and morphine consumption.
Deep NMB achieved significantly higher Surgical Rating Scale scores compared to moderate NMB (P < 0.001).
Postoperative shoulder pain was significantly reduced in the deep NMB group (P < 0.001).
Lower Visual Analog Scale scores were noted at multiple time points in the deep NMB group (P < 0.001).
Deep NMB resulted in decreased morphine consumption 72 hours post-hysterectomy (P < 0.001).
Recovery index and postoperative complications showed no significant differences between the groups.

Abstract

To evaluate the impact of neuromuscular blockade (NMB) depth on surgical conditions and postoperative outcomes in patients undergoing laparoendoscopic single-site (LESS) surgery for total hysterectomy. A total of 243 female patients scheduled for LESS surgery for total hysterectomy under intravenous anesthesia were randomly allocated to two groups: the deep NMB group (1–2 post-tetanic count) and the moderate NMB group (1–2 train-of-four response) with continuous intravenous infusion of cisatracurium. The primary endpoint was the Surgical Rating Scale (SRS) score during the surgery. Secondary endpoints included additional NMB requirements during surgery, and postoperative outcomes including Visual Analog Scale (VAS) scores, incidence of shoulder pain, morphine consumption, and the incidence of nausea and vomiting. Mean (standard deviation) SRS was 4.31 (0.86) during moderate NMB and 4.75 (0.54) during deep NMB (P 0.05). Deep NMB significantly improves surgical conditions during LESS hysterectomy while reducing postoperative pain.

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