{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:01:10Z","timestamp":1786122070654,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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\u2013remifentanil 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) \u2265 4. Group CI received 0.3 mg\/kg\/h after intubation, titrated to maintain PTC \u2264 3. The primary outcome was body weight- and time-normalized total rocuronium requirement, including the intubating dose; the equivalence margin was \u00b10.13 mg\/kg\/h. Results: Rocuronium requirements were 0.84 \u00b1 0.21 mg\/kg\/h in Group B and 0.85 \u00b1 0.26 mg\/kg\/h in Group CI (mean difference, 0.010; 90% CI, \u22120.087 to 0.108), within the prespecified equivalence margin. A post hoc sensitivity analysis excluding the intubating dose showed no significant difference (0.38 \u00b1 0.14 vs. 0.37 \u00b1 0.13 mg\/kg\/h; mean difference, \u22120.012; 95% CI, \u22120.075 to 0.051; p = 0.707). Deep NMB duration (127 \u00b1 43 vs. 132 \u00b1 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.<\/jats:p>","DOI":"10.3390\/jcm15166135","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:01:36Z","timestamp":1786089696000},"page":"6135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Total Rocuronium Requirement During Intermittent Bolus Versus Continuous Infusion for Deep Neuromuscular Block in Elective Abdominal Cancer Surgery: A Randomized Equivalence Trial"],"prefix":"10.3390","volume":"15","author":[{"given":"Ju Deok","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Wook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyung Joo","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sie Jeong","family":"Ryu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doo Sik","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungbo","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6614-9244","authenticated-orcid":false,"given":"Donghee","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1093\/bja\/87.6.912","article-title":"The new neuromuscular blocking agents: Do they offer any advantages?","volume":"87","author":"Moore","year":"2001","journal-title":"Br. J. Anaesth."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1093\/bja\/76.1.29","article-title":"Pharmacokinetics of rocuronium after bolus and continuous infusion during halothane anaesthesia","volume":"76","author":"McCoy","year":"1996","journal-title":"Br. J. Anaesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1007\/s00540-016-2174-5","article-title":"The predictive ability of six pharmacokinetic models of rocuronium developed using a single bolus: Evaluation with bolus and continuous infusion regimen","volume":"30","author":"Sasakawa","year":"2016","journal-title":"J. Anesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1097\/EJA.0000000000000934","article-title":"Comparison of rocuronium requirement in children with continuous infusion versus intermittent bolus: A randomised controlled trial","volume":"36","author":"Choi","year":"2019","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.cct.2012.01.002","article-title":"Comparative study on the pharmacodynamics of cisatracurium: Continuous infusion or intermittent bolus injection","volume":"33","author":"Dong","year":"2012","journal-title":"Contemp. Clin. Trials"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"64","DOI":"10.2174\/1574884714666191120144331","article-title":"Systematic review on rocuronium continuous infusion for deep neuromuscular blockade","volume":"16","author":"Couto","year":"2021","journal-title":"Curr. Rev. Clin. Exp. Pharmacol. Former. Curr. Clin. Pharmacol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1093\/bja\/aet377","article-title":"Evaluation of surgical conditions during laparoscopic surgery in patients with moderate vs deep neuromuscular block","volume":"112","author":"Martini","year":"2014","journal-title":"Br. J. Anaesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1213\/ANE.0b013e3181fdf889","article-title":"The duration of residual neuromuscular block after administration of neostigmine or sugammadex at two visible twitches during train-of-four monitoring","volume":"112","author":"Illman","year":"2011","journal-title":"Anesth. Analg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"14568","DOI":"10.1038\/s41598-021-94062-2","article-title":"Comparison between the trapezius and adductor pollicis muscles as an acceleromyography monitoring site for moderate neuromuscular blockade during lumbar surgery","volume":"11","author":"Oh","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1002\/sim.1783","article-title":"Sample sizes for clinical trials with normal data","volume":"23","author":"Julious","year":"2004","journal-title":"Stat. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/anae.14872","article-title":"A comparison of a prototype electromyograph vs. a mechanomyograph and an acceleromyograph for assessment of neuromuscular blockade","volume":"75","author":"Bowdle","year":"2020","journal-title":"Anaesthesia"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.resuscitation.2017.08.238","article-title":"Continuous versus intermittent neuromuscular blockade in patients during targeted temperature management after resuscitation from cardiac arrest\u2014A randomized, double blinded, double dummy, clinical trial","volume":"120","author":"Testori","year":"2017","journal-title":"Resuscitation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s12976-021-00147-w","article-title":"On the relationship between inhibition and receptor occupancy by nondepolarizing neuromuscular blocking drugs","volume":"18","author":"Hoshino","year":"2021","journal-title":"Theor. Biol. Med. Model."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/EJA.0b013e328356bc24","article-title":"Train-of-four recovery does not indicate optimal recovery of the margin of safety of neuromuscular transmission","volume":"30","author":"Mirzakhani","year":"2013","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/0952-8180(92)90221-L","article-title":"Pharmacodynamic effects of three doses of ORG 9426 used for endotracheal intubation in humans","volume":"4","author":"Dubois","year":"1992","journal-title":"J. Clin. Anesth."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/bja\/78.3.267","article-title":"Pharmacodynamics and pharmacokinetics of rocuronium in intensive care patients","volume":"78","author":"Sparr","year":"1997","journal-title":"Br. J. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1007\/BF03024863","article-title":"Cumulation characteristics of cisatracurium and rocuronium during continuous infusion","volume":"47","author":"Miller","year":"2000","journal-title":"Can. J. Anesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1111\/aas.12699","article-title":"Is deep neuromuscular block beneficial in laparoscopic surgery? No, probably not","volume":"60","author":"Kopman","year":"2016","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1093\/bja\/aev368","article-title":"Deep neuromuscular block improves the surgical conditions for laryngeal microsurgery","volume":"115","author":"Kim","year":"2015","journal-title":"Br. J. Anaesth."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/bja\/aem124","article-title":"Post-tetanic count at adductor pollicis is a better indicator of early diaphragmatic recovery than train-of-four count at corrugator supercilii","volume":"99","author":"Dhonneur","year":"2007","journal-title":"Br. J. Anaesth."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"744","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_22","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1093\/bja\/aex116","article-title":"Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: A systematic review and meta-analysis","volume":"118","author":"Bruintjes","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/aas.12493","article-title":"Optimising abdominal space with deep neuromuscular blockade in gynaecologic laparoscopy\u2013a randomised, blinded crossover study","volume":"59","author":"Madsen","year":"2015","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/ALN.0000000000004044","article-title":"Quantitative neuromuscular monitoring and postoperative outcomes: A narrative review","volume":"136","author":"Murphy","year":"2022","journal-title":"Anesthesiology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1213\/ANE.0000000000002670","article-title":"Consensus statement on perioperative use of neuromuscular monitoring","volume":"127","author":"Naguib","year":"2018","journal-title":"Anesth. Analg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"133","DOI":"10.17085\/apm.21014","article-title":"The latest trend in neuromuscular monitoring: Return of the electromyography","volume":"16","author":"Lee","year":"2021","journal-title":"Anesth. Pain Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"109962","DOI":"10.1016\/j.jclinane.2020.109962","article-title":"Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies","volume":"66","author":"Raval","year":"2020","journal-title":"J. Clin. Anesth."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1213\/ane.0b013e3181ac53c3","article-title":"Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: A multicenter, randomized, controlled trial","volume":"110","author":"Wattwil","year":"2010","journal-title":"Anesth. Analg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"495","DOI":"10.4097\/kjae.2013.65.6.495","article-title":"Sugammadex: Clinical development and practical use","volume":"65","author":"Meistelman","year":"2013","journal-title":"Korean J. Anesthesiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1097\/00003643-200410000-00005","article-title":"Rocuronium duration of action under sevoflurane, desflurane or propofol anaesthesia","volume":"21","author":"Maidatsi","year":"2004","journal-title":"Eur. J. Anaesthesiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6135\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T08:25:14Z","timestamp":1786091114000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/16\/6135"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":30,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15166135"],"URL":"https:\/\/doi.org\/10.3390\/jcm15166135","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]}}}