Comparison of Neostigmine with Train-of-Four Monitoring Versus without Train-of-Four Monitoring in Reversal of Neuromuscular Blockade and Incidence of Postoperative Pulmonary Complications: Randomized Controlled Trial in a Tertiary Care Centre, Chengalpat

Abstract

Background: Applying Train-of-four (TOF) monitoring resulted in less residual paralysis in the postoperative room. The purpose of this study was to determine whether neostigmine reversal optimization without TOF monitoring was comparable to reversal with TOF monitoring. 
Methods: Eighty patients between the ages of 18 and 60 undergoing Elective Laparoscopic surgery under General Anaesthesia, (vecuronium and sevoflurane). Randomization was used to split Anaesthesia with intubation into two groups: Group A (n = 40) that used an improved neostigmine reversal method without TOF monitoring and a quantitative TOF monitoring as a neostigmine reversal approach (group B, n = 40). According to protocol The incidence of residual paralysis in the postoperative room was compared between the two pairs. 
Results: In the postoperative room, group A experienced six residual paralysis, while there was one instance in group B. The Comparative analysis showed that the 95% confidence interval of this study was outside the range of equivalence margin (15%). The absolute difference was 13.9% standard error (SE) =0.068 (P = 0.107; 95% confidence interval (CI): 1%, 27.2%). In both groups, no patients had TOF ratio < 0.70 in the postoperative room. The TOF ratio in the postoperative room did not differ between the two groups (mean difference: −2.58; P = 0.05; 95% CI: −5.20, 0.29). One respiratory adverse event occurred in this study. 
Conclusion: Our study demonstrated that, in order to prevent residual paralysis in the postoperative room after using vecuronium as a neuromuscular blocking agent and sevoflurane as maintanence anaesthesia, optimised reversal strategy without Train-Of- Monitoring is different from a reversal strategy based on quantitative Train-Of- Monitoring.Further studies are needed to confirm it.