{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T19:44:48Z","timestamp":1777664688675,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T00:00:00Z","timestamp":1756598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Laparoscopic gynecologic surgery is widely utilized due to its minimally invasive nature. Postoperative discomfort, including intra-abdominal and referred shoulder pain, remains a challenge. This study evaluates the impact of deep neuromuscular blockade (NMB) reversed with sugammadex compared to moderate NMB reversed with neostigmine on postoperative pain, recovery, and surgical conditions in patients undergoing laparoscopic hysterectomy. Methods: This double-blind, randomized controlled trial included 228 patients undergoing laparoscopic hysterectomy under standardized pneumoperitoneum pressure (12 mmHg). Participants were randomized into two groups: deep NMB with sugammadex (SUG) and moderate NMB with neostigmine (NEO). Primary outcomes included postoperative pain (NRS) and neuromuscular recovery time (TOF ratio \u2265 0.9). Secondary outcomes were surgical conditions, surgeon satisfaction, extubation and recovery times, incidence of postoperative nausea and vomiting (PONV), and analgesic consumption. Results: The SUG group exhibited lower pain scores up to 24 h compared to the NEO group (p &lt; 0.05). Pain reductions remained statistically significant up to 6 h postoperatively after Bonferroni correction, while differences beyond this time were not significant after adjustment. Neuromuscular recovery was markedly faster in the SUG group (147.58 \u00b1 82.26 s vs. 488.02 \u00b1 223.07 s, p &lt; 0.05). Patients in the SUG group had shorter extubation (\u0394T1), awakening (\u0394T2), and recovery room transfer times (\u0394T3). PONV was significantly lower in the SUG group. Deep NMB did not contribute to the improvement of surgical workspace conditions. Conclusions: Deep NMB with sugammadex enhances postoperative pain control and accelerates neuromuscular recovery in laparoscopic hysterectomy. These findings support the adoption of deep NMB with sugammadex as a valid anesthetic approach in laparoscopic hysterectomy procedures.<\/jats:p>","DOI":"10.3390\/jcm14176163","type":"journal-article","created":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T13:01:13Z","timestamp":1756818073000},"page":"6163","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Role of Deep Neuromuscular Blockade and Sugammadex in Laparoscopic Hysterectomy: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"14","author":[{"given":"Corrado","family":"Terranova","sequence":"first","affiliation":[{"name":"Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2168-9017","authenticated-orcid":false,"given":"Lorenzo","family":"Schiavoni","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Plotti","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2519-9904","authenticated-orcid":false,"given":"Fabio","family":"Costa","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Feole","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3991-0469","authenticated-orcid":false,"given":"Stefania","family":"Rampello","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2474-2442","authenticated-orcid":false,"given":"Fernando","family":"Ficarola","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecological Unit, Department of Woman\u2019s and Child\u2019s Health, San Camillo-Forlanini Hospital, 00152 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Montera","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Guzzo","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3537-7014","authenticated-orcid":false,"given":"Daniela","family":"Luvero","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9254-5790","authenticated-orcid":false,"given":"Violante","family":"Di Donato","sequence":"additional","affiliation":[{"name":"Department of Gynecological, Obstetrical and Urological Sciences, \u201cSapienza\u201d University of Rome, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7571-6121","authenticated-orcid":false,"given":"Alessia","family":"Mattei","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Angioli","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"De Cicco Nardone","sequence":"additional","affiliation":[{"name":"Department of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy"},{"name":"Research Unit of Gynecology Oncology, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.bpg.2013.11.001","article-title":"Laparoscopy in the era of enhanced recovery","volume":"28","author":"Rockall","year":"2014","journal-title":"Best Pr. Res. Clin. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00464-015-4454-9","article-title":"What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review","volume":"30","author":"Brunschot","year":"2015","journal-title":"Surg. Endosc."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Yi, S.W. (2022). Residual intraperitoneal carbon dioxide gas following laparoscopy for adnexal masses: Residual gas volume assessment and postoperative outcome analysis. Medicine, 101.","DOI":"10.1097\/MD.0000000000030142"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1097\/EJA.0000000000000094","article-title":"Deep neuromuscular block improves surgical conditions during laparoscopic hysterectomy","volume":"31","author":"Dubois","year":"2014","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/aas.12419","article-title":"Neuromuscular blockade for optimising surgical conditions during abdominal and gynaecological surgery: A systematic review","volume":"59","author":"Madsen","year":"2015","journal-title":"Acta Anaesthesiol Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1007\/s00404-017-4325-9","article-title":"Association between intraabdominal pressure during gynaecologic laparoscopy and postoperative pain","volume":"295","author":"Kundu","year":"2017","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13063-021-05638-2","article-title":"The impact of deep versus standard neuromuscular block on intraoperative safety during laparoscopic surgery: An international multicenter randomized controlled double-blind strategy trial\u2014EURO-RELAX TRIAL","volume":"22","author":"Honing","year":"2021","journal-title":"Trials"},{"key":"ref_8","first-page":"1","article-title":"Effects of deep neuromuscular block with low-pressure pneumoperitoneum on respiratory mechanics and biotrauma in a steep Trendelenburg position","volume":"11","author":"Kim","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/XCS.0000000000000061","article-title":"Impact of the Deep Neuromuscular Block on Oncologic Quality of Laparoscopic Surgery in Obese Gastric Cancer Patients: A Randomized Clinical Trial","volume":"234","author":"Huh","year":"2022","journal-title":"J. Am. Coll. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1097\/SLE.0000000000000049","article-title":"Sugammadex Reduces Postoperative Pain After Laparoscopic Bariatric Surgery","volume":"24","author":"Castro","year":"2014","journal-title":"Surg. Laparosc. Endosc. Percutaneous Tech."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1001\/jamasurg.2015.3934","article-title":"Underlying mechanisms of postoperative pain after laparoscopic surgery","volume":"151","author":"Golzari","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.jpain.2018.09.012","article-title":"Deep Tissue Incision Enhances Spinal Dorsal Horn Neuron Activity During Static Isometric Muscle Contraction in Rats","volume":"20","author":"Gu","year":"2019","journal-title":"J. Pain"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Raval, A.D., Deshpande, S., Rabar, S., Koufopoulou, M., Neupane, B., Iheanacho, I., Bash, L.D., Horrow, J., Fuchs-Buder, T., and Farag, E. (2020). Does deep neuromuscular blockade during laparoscopy procedures change patient, surgical, and healthcare resource outcomes? A systematic review and meta-analysis of randomized controlled trials. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0231452"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1046\/j.1365-2168.2001.01729-7.x","article-title":"Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy","volume":"88","author":"Bala","year":"2001","journal-title":"Br. J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kathopoulis, N., Protopapas, A., Stamatakis, E., Chatzipapas, I., Zacharakis, D., Grigoriadis, T., Athanasiou, S., and Valsmidis, D. (2022). Deep versus Moderate Neuromuscular Blockade in Gynecologic Laparoscopic Operations: Randomized Controlled Trial. J. Pers. Med., 12.","DOI":"10.3390\/jpm12040561"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1093\/bja\/aew466","article-title":"Measuring acute postoperative pain using the visual analog scale: The minimal clinically important difference and patient acceptable symptom state","volume":"118","author":"Myles","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1093\/bja\/aer195","article-title":"Determination of moderate-to-severe postoperative pain on the numeric rating scale: A cut-off point analysis applying four different methods","volume":"107","author":"Gerbershagen","year":"2011","journal-title":"Br. J. Anaesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1097\/EJA.0000000000000360","article-title":"Postoperative shoulder pain after laparoscopic hysterectomy with deep neuromuscular blockade and low-pressure pneumoperitoneum: A randomised controlled trial","volume":"33","author":"Madsen","year":"2016","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"121","DOI":"10.5114\/ait.2024.141209","article-title":"Evaluation of surgical condition during laparoscopic gynaecological surgery in patients with moderate vs. deep neuromuscular block in low-pressure pneumoperitoneum","volume":"56","author":"Esa","year":"2024","journal-title":"Anaesthesiol. Intensiv. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jclinane.2016.07.030","article-title":"Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: A randomized controlled trial","volume":"35","author":"Putz","year":"2016","journal-title":"J. Clin. Anesthesia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/EJA.0000000000000010","article-title":"Retrospective investigation of postoperative outcome after reversal of residual neuromuscular blockade: Sugammadex, neostigmine or no reversal","volume":"31","author":"Ledowski","year":"2014","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_22","first-page":"147","article-title":"Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting","volume":"67","author":"Mutlu","year":"2017","journal-title":"Braz. J. Anesthesiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1097\/JS9.0000000000002194","article-title":"Systematic analysis of sugammadex-related adverse drug reaction signals using FAERS database","volume":"111","author":"Liu","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1213\/ANE.0000000000005842","article-title":"Sugammadex Versus Neostigmine for Reversal of Residual Neuromuscular Blocks After Surgery: A Retrospective Cohort Analysis of Postoperative Side Effects","volume":"134","author":"Ruetzler","year":"2022","journal-title":"Anesthesia Analg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6163\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:36:40Z","timestamp":1760035000000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,31]]},"references-count":24,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14176163"],"URL":"https:\/\/doi.org\/10.3390\/jcm14176163","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,31]]}}}