Mean eVAS responses following treatment with placebo (A), oral morphine immediate release 40 mg (B) and oral tapentadol immediate release 100 mg (C) at 60–90 min after drug intake.

<p>The blue dots are the responses to the test stimulus without conditioning stimulus, the orange dots the responses to the test stimulus with conditioning stimulus. The broken line is the mean temperature of the test stimulus. Values are ± SEM.</p

Consort flow diagram.

<p>The test stimulus temperatures (heat pain) as determined prior to treatment averaged to 47 ± 0.5°C, 46.6 ± 0.5°C and 46.9 ± 0.5°C on placebo, morphine and tapentadol experimental sessions (one-way anova: NS). The target conditioning stimulus temperatures were 7.9 ± 0.5°C, 8.1 ± 0.6°C and 8.3 ± 0.6°C on placebo, morphine and tapentadol experimental sessions (one-way anova: NS).</p

The setup used to induce Conditioned Pain Modulation (CPM).

<p>The volunteer sits on the bed while a thermal test stimulus is applied to the arm <i>via</i> a 3×3 cm thermode (insert top right). The leg is placed in a bucket filled with cold water (<i>ie</i>. the conditioning stimulus) and the subject scores the heat pain to the arm using an electronic visual analogue scale (insert top middle). The cold water is applied via the Icydip system; the heat pain via Medoc’s pathway system.</p

Impact of high- <i>versus</i> low-dose neuromuscular blocking agent administration on unplanned 30-day readmission rates in retroperitoneal laparoscopic surgery

<div><p>Recent data shows that a neuromuscular block (NMB) induced by administration of high doses of rocuronium improves surgical conditions in certain procedures. However, there are limited data on the effect such practices on postoperative outcomes. We performed a retrospective analysis to compare unplanned 30-day readmissions in patients that received high-dose <i>versus</i> low-dose rocuronium administration during general anesthesia for laparoscopic retroperitoneal surgery. This retrospective cohort study was performed in the Netherlands in an academic hospital where routine high-dose rocuronium NMB has been practiced since July 2015. Charts of patients receiving anesthesia between January 2014 and December 2016 were searched for surgical cases receiving high-dose rocuronium and matched with respect to procedure, age, sex and ASA classification to patients receiving low-dose rocuronium. The primary post-operative outcome was unplanned 30-day readmission rate. There were 130 patients in each cohort. Patients in the high- and low-dose rocuronium cohorts received 217 ± 49 <i>versus</i> 37 ± 5 mg rocuronium, respectively. In the high-dose rocuronium group neuromuscular activity was consistently monitored; matched patients were unreliably monitored. All patients receiving high-dose rocuronium were reversed with sugammadex, while just 33% of matched patients were reversed with sugammadex and 20% with neostigmine; the remaining patients were not reversed. Unplanned 30-day readmission rate was significantly lower in the high-dose compared to the low-dose rocuronium cohort (3.8% <i>vs</i>. 12.7%; p = 0.03; odds ratio = 0.33, 95% C.I. 0.12–0.95). This small retrospective study demonstrates a lower incidence of unplanned readmissions within 30-days following laparoscopic retroperitoneal surgery with high-dose relaxant anesthesia and sugammadex reversal in comparison to low-dose relaxant anesthesia. Further prospective studies are needed in larger samples to corroborate our findings and additionally assess the pharmacoeconomics of high-dose relaxant anesthesia taking into account the benefits (reduced readmissions) and harm (cost of relaxants and reversal agents) of such practice.</p></div

Patient characteristics and retroperitoneal laparoscopic procedures.

<p>Patient characteristics and retroperitoneal laparoscopic procedures.</p

Measurements during anesthesia.

<p>Measurements during anesthesia.</p

30-day unplanned readmission.

<p>30-day unplanned readmission.</p

Medication administered during anesthesia.

<p>Medication administered during anesthesia.</p