Key result
Acceleromyography monitoring at the trapezius muscle during lumbar surgery required a significantly higher intraoperative rocuronium dose (106.4 mg vs 74.1 mg) for moderate neuromuscular blockade compared to the adductor pollicis muscle.
Why the study?
Acceleromyography at the distally located adductor pollicis may not reflect neuromuscular blockade at proximally located muscles manipulated during lumbar surgery.
Does acceleromyography monitoring at the trapezius muscle compared to the adductor pollicis muscle alter the required rocuronium dose and surgical conditions in patients undergoing lumbar surgery?
RCT (n=50)
Double-blind
Web-based computer-generated list
No
Does acceleromyography monitoring at the trapezius muscle compared to the adductor pollicis muscle alter the required rocuronium dose and surgical conditions in patients undergoing lumbar surgery?
Acceleromyography at the trapezius muscle during lumbar surgery requires a higher rocuronium dose for moderate neuromuscular blockade than at the adductor pollicis muscle, resulting in deeper blockade and better surgical conditions.
Clinicians should account for monitoring site when targeting moderate neuromuscular blockade; extends RCT evidence on acceleromyography locations.
Acceleromyography at the adductor pollicis located in a distal part of the body may not reflect the degree of neuromuscular blockade (NMB) at the proximally located muscles manipulated during lumbar surgery. We investigated the usefulness and characteristics of acceleromyographic monitoring at the trapezius for providing moderate NMB during lumbar surgery. Fifty patients were randomized to maintain a train-of-four count 1-3 using acceleromyography at the adductor pollicis (group A; n = 25) or the trapezius (group T; n = 25). Total rocuronium dose administered intraoperatively [mean ± SD, 106.4 ± 31.3 vs. 74.1 ± 17.6 mg; P < 0.001] and surgical satisfaction (median [IQR], 7 [5-8] vs. 5 [4-5]; P < 0.001) were significantly higher in group T than group A. Lumbar retractor pressure (88.9 ± 12.0 vs. 98.0 ± 7.8 mmHg; P = 0.003) and lumbar muscle tone in group T were significantly lower than group A. Time to maximum block with an intubating dose was significantly shorter in group T than group A (44 [37-54] vs. 60 [55-65] sec; P < 0.001). Other outcomes were comparable. Acceleromyography at the trapezius muscle during lumbar surgery required a higher rocuronium dose for moderate NMB than the adductor pollicis muscle, thereby the consequent deeper NMB provided better surgical conditions. Trapezius as proximal muscle may better reflect surgical conditions of spine muscle.
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Oh et al. (2021) conducted an RCT in Elective lumbar spine surgery (n=50). Acceleromyography monitoring at the trapezius muscle vs. Acceleromyography monitoring at the adductor pollicis muscle was evaluated on Total rocuronium dose administered intraoperatively (p=<0.001). Acceleromyography monitoring at the trapezius muscle during lumbar surgery required a significantly higher intraoperative rocuronium dose (106.4 mg vs 74.1 mg) for moderate neuromuscular blockade compared to the adductor pollicis muscle.
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