Key result
Acceleromyography monitoring at the trapezius muscle required a significantly higher total rocuronium dose (106.4 mg vs 74.1 mg, p<0.001) to maintain moderate neuromuscular blockade compared to the adductor pollicis muscle.
Why the study?
Acceleromyography at the distal adductor pollicis may not reflect neuromuscular blockade at proximal muscles manipulated during lumbar surgery.
Does acceleromyography monitoring at the trapezius muscle compared to the adductor pollicis muscle alter rocuronium requirements and improve surgical conditions in patients undergoing elective lumbar spine 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 rocuronium requirements and improve surgical conditions in patients undergoing elective lumbar spine surgery?
Acceleromyography at the trapezius muscle during lumbar surgery requires a higher rocuronium dose for moderate neuromuscular blockade than at the adductor pollicis muscle, but provides better surgical conditions.
Trapezius acceleromyography may prompt higher rocuronium dosing; leaves open the preferred monitoring site for neuromuscular blockade.
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 providing better surgical conditions. Trapezius as proximal muscle better reflects surgical conditions of spine muscle.
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Oh et al. (2021) conducted an RCT in 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 required a significantly higher total rocuronium dose (106.4 mg vs 74.1 mg, p<0.001) to maintain moderate neuromuscular blockade compared to the adductor pollicis muscle.
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