Effects of Deep versus Moderate Neuromuscular Blockade on Postoperative Acute and Chronic Pain in Laparoscopic Gynecological Surgery

Ying Zhao, Jingjing Zhang, Wei Qian, Hailing Mu, Qiushuang Tang, Peng Zhang Department of Anesthesiology, The Second People’s Hospital, Wuhu, Anhui, People’s Republic of ChinaCorrespondence: Peng Zhang, Department of Anesthesiology, The Second People’s Hospital, Wuhu, Anhui, People’s Republic of China, Tel +86 180 5531 6106, Email mazuizp@163.comPurpose: To evaluate the effects of deep neuromuscular blockade (D-NMB) versus moderate NMB (M-NMB) on postoperative pain and chronic postsurgical pain (CPSP) in patients undergoing laparoscopic gynecological surgery.Patients and Methods: Seventy-two patients scheduled for laparoscopic uterine or adnexal surgery were randomly assigned to Group D (D-NMB, post-tetanic count 1– 2) or Group M (M-NMB, train-of-four count 1– 2). Postoperative pain was assessed using the visual analogue scale (VAS) at multiple time points. Surgeon satisfaction score (SRS), opioid consumption, Quality of Recovery-15 (QoR-15) score, and CPSP incidence at 3 and 6 months were compared.Results: The VAS score at 0.5 hours postoperatively was significantly lower in Group D than in Group M (4.18± 1.40 vs. 5.42± 1.61, P=0.001). Postoperative opioid consumption and the proportion requiring additional analgesia were significantly reduced in Group D (P=0.011 and P=0.019, respectively).SRS and QoR-15 scores were significantly higher in Group D (P< 0.001 and P=0.022, respectively). No significant differences were observed in CPSP incidence or adverse reactions between the two groups.Conclusion: D-NMB improves early postoperative pain control, reduces opioid requirements, and enhances surgeon satisfaction and early recovery quality without increasing adverse events, but does not reduce CPSP incidence.Keywords: neuromuscular blockade, postoperative pain, deep neuromuscular blockade, chronic postsurgical pain