# Efficacy evaluation of neuromuscular blocking agents as adjuncts to intravenous regional anesthesia: a meta-analysis of randomized controlled trials

## TL;DR

This study finds that adding neuromuscular blocking agents to intravenous regional anesthesia speeds up the onset of sensory and motor blocks and prolongs motor block duration.

## Contribution

The novel contribution is a meta-analysis showing that neuromuscular blocking agents improve the efficacy of intravenous regional anesthesia.

## Key findings

- NMBAs significantly shorten the onset time of sensory and motor blocks.
- NMBAs prolong the duration of motor block but not pain relief duration.
- Anesthetic quality remains comparable to standard IVRA techniques.

## Abstract

To evaluate the efficacy of neuromuscular blocking agents (NMBAs) as adjuncts to intravenous regional anesthesia (IVRA).

Two researchers independently searched PUBMED, EMBASE, the Cochrane Library databases, and CBM for randomized controlled trials assessing the efficacy of NMBAs as adjuvants in IVRA.

This meta-analysis included 420 patients from 7 randomized controlled trials. Compared to IVRA using local anesthetics alone, the adjunctive use of NMBAs significantly shortened the onset time of sensory block [mean difference (MD) = −1.38 min, 95% CI: −2.02 to −0.75; P < 0.01] and motor block (MD = −2.39 min, 95% CI: −4.67 to −0.12; P = 0.04). Moreover, NMBAs prolonged the duration of motor block (MD = 6.97 min, 95% CI: 0.06 to 13.88; P = 0.05). However, no significant improvement was observed in the duration of pain relief (MD = 4.24 min, 95% CI: −1.43 to 9.91; P = 0.14).

As adjuncts to IVRA, NMBAs significantly reduce the onset time of sensory and motor blocks compared to local anesthetics alone. Additionally, NMBAs prolong the duration of motor block. These agents enhance the efficacy of IVRA by optimizing neuromuscular blockade while maintaining anesthetic quality comparable to standard IVRA techniques.