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

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.