Effect Of Deep Neuromuscular Blockade On Serum Cytokines And Postoperative Delirium In Elderly Patients Undergoing Total Hip Replacement A Prospective Single-Blind Randomised Controlled Trial

BACKGROUND Deep neuromuscular blockade (NMB) may reduce muscle injury and related inflammation. The inflammation is one of the pathophysiological processes of peri-operative complications. OBJECTIVE To compare the degree of inflammation and related postoperative complications including postoperative delirium (POD) and peri-operative bleeding according to the degree of NMB during general anaesthesia for total hip replacement. DESIGN A prospective, single-blind, randomised controlled trial. SETTING Tertiary, university hospital, single centre. PATIENTS Eighty-two patients undergoing total hip replacement surgery were included in the final analysis. INTERVENTIONS Moderate (Mod) and deep (Deep) NMB groups. MAIN OUTCOME MEASURES The changes in inflammatory cytokines were measured. The incidence of POD was evaluated by using confusion assessment method (CAM). The differences of postoperative bleeding and peri-operative oxygenation in both groups were also measured. RESULTS The NMB reversal duration was significantly longer in the Mod NMB group than in the Deep NMB group. Changes in interleukin-6 were significantly smaller in the Deep NMB group than in the Mod NMB group (P < 0.001). The incidence of POD was not significantly different between groups (34 versus 17% in Mod and Deep NMB groups, respectively; P = 0.129). The amount of postoperative bleeding until postoperative day 2 was significantly greater in the Mod NMB group than in the Deep NMB group (P = 0.027). CONCLUSION Our findings suggest that inflammation related to peri-operative complications could be associated with the depth of NMB during total hip replacement. However, the incidence of POD might not be associated to the depth of NMB.