Total Rocuronium Requirement During Intermittent Bolus Versus Continuous Infusion for Deep Neuromuscular Block in Elective Abdominal Cancer Surgery: A Randomized Equivalence Trial

Abstract

Background/Objectives: This study compared rocuronium requirements, duration of deep neuromuscular blockade (NMB), and recovery profiles between intermittent bolus and continuous infusion administration. Methods: This prospective, single-center, randomized equivalence trial enrolled 72 adults undergoing elective abdominal cancer surgery under sevoflurane–remifentanil anesthesia. The per-protocol analysis included 67 patients (Group B, n = 34; Group CI, n = 33); five were excluded after neuromuscular monitoring failures precluded primary-outcome calculation. Group B received rocuronium 0.15 mg/kg at post-tetanic count (PTC) ≥ 4. Group CI received 0.3 mg/kg/h after intubation, titrated to maintain PTC ≤ 3. The primary outcome was body weight- and time-normalized total rocuronium requirement, including the intubating dose; the equivalence margin was ±0.13 mg/kg/h. Results: Rocuronium requirements were 0.84 ± 0.21 mg/kg/h in Group B and 0.85 ± 0.26 mg/kg/h in Group CI (mean difference, 0.010; 90% CI, −0.087 to 0.108), within the prespecified equivalence margin. A post hoc sensitivity analysis excluding the intubating dose showed no significant difference (0.38 ± 0.14 vs. 0.37 ± 0.13 mg/kg/h; mean difference, −0.012; 95% CI, −0.075 to 0.051; p = 0.707). Deep NMB duration (127 ± 43 vs. 132 ± 65 min; p = 0.687) and recovery after sugammadex did not differ significantly. Six Group CI patients (18.2%) required rescue boluses. Conclusions: The strategies yielded equivalent normalized total rocuronium requirements within the prespecified margin. Recovery outcomes did not differ significantly; however, the infusion protocol required rescue boluses in some patients. PTC-guided individualization is therefore needed.