Is deep neuromuscular block beneficial in laparoscopic surgery? No, probably not.

Abstract

There is currently a controversy regarding the need for and clinical benefit of maintaining deep neuromuscular block (post-tetanic counts of 1 or 2) vs. moderate block (train-of-four counts of 1-3) for routine laparoscopic surgery. Two recent review articles on this subject arrived at rather different conclusions. This manuscript is part of Pro/Con debate from the authors of these two reviews. The authors of the Pro and Con sides of the debate had the opportunity to read each other manuscripts and worked from the same basic database of references. The present authors could find only one peer-reviewed paper which presented objective evidence supporting the proposition that deep neuromuscular block provides superior operating conditions for the surgeon during laparoscopic surgery. There is not enough good evidence available to justify the routine use of deep neuromuscular block for laparoscopic surgery and the associated expense of high-dose sugammadex.