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

Purpose: 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.