Anaesthetic protocol
Neuromuscular blockade, NRS, neuromuscular blockade, pain
NEUROMUSCULAR BLOCKADE, NEUROMUSCULAR BLOCKADE
SA was performed thirty minutes before the onset of surgery using a standardized technique, consisting of 10 mg of intrathecal isobaric bupivacaine 0.5% administered at level L4–L5. During spinal anaesthesia, MAC was established with the administration of intravenous (IV) midazolam 1–2 mg and S-ketamine 5 mg. MAC was defined as the administration of anesthetics with the goal of patient comfort, while preserving meaningful patient contact. During surgery, MAC was administered to patients with IV propofol through target-controlled infusion (TCI); a target effect site concentration (EC) was maintained at 1.0 µg/ml (Marsh model).During the induction of GA, patients received IV fentanyl 2 µg/kg and IV propofol through TCI; a target EC was maintained at 3.0 µg/ml (Marsh model) as maintenance of anaesthesia. Neuromuscular blockade was obtained with IV rocuronium 0.6 mg/kg. At the end of surgery, the neuromuscular blockade was reversed with the administration of IV sugammadex 4 mg/kg.Intraoperatively, all patients received IV paracetamol 15 mg/kg (with a maximum dose of 1000 mg) and IV ketorolac 0.5 mg/kg (with a maximum dose of 30 mg). In the PACU, pain was treated by titrating IV piritramide 0.02 mg/kg, until the patient reported a NRS of 4 or less as per institutional protocol. On the ward, patients received IV paracetamol 15 mg/kg (with a maximum dose of 1000 mg) every 6 h and IV ketorolac 0.5 mg/kg (with a maximum dose of 30 mg) every 8 h. Intramuscular (IM) piritramide 0.2 mg/kg (maximum dose of 15 mg) up to four times a day was administered parenterally for NRS scores higher than 4. After oral intake was resumed, the oral analgesia protocol consisted of paracetamol 1000 mg each 6 h; diclofenac 75 mg each 12 h; tramadol slow-release 100 mg each 12 h; and tramadol fast-release 50 mg up to 4 times a day, when NRS were higher than 4.