Deep versus moderate neuromuscular blockade on postoperative recovery quality: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: Advances in neuromuscular monitoring and reversal agents have facilitated the widespread clinical adoption of deep neuromuscular blockade (dNMB). Nevertheless, whether dNMB improves postoperative recovery quality compared with moderate neuromuscular blockade (mNMB) remains unclear.

METHODS

We systematically searched PubMed, EMBASE, and the Cochrane Library up to January 31, 2026. Eligible studies were randomized controlled trials (RCTs) enrolling adult surgical patients, comparing dNMB versus mNMB, and reporting postoperative recovery quality measured by the Quality of Recovery-40 (QoR-40) or Quality of Recovery-15 (QoR-15) questionnaire. Pooled standardized mean differences (SMDs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated. The Cochrane RoB 2 tool was used to assess risk of bias, and the GRADE approach was applied to evaluate the certainty of evidence. The study protocol was registered in PROSPERO (CRD420261302047).

RESULTS

A total of five RCTs encompassing 507 patients were included in the analysis. dNMB did not demonstrate superior postoperative recovery quality on postoperative day 1 (POD 1) (SMD = 0.36, 95% CI =-0.01 to 0.72) or POD 2 (SMD = -0.04, 95% CI = -0.35 to 0.27).

CONCLUSION

Compared with mNMB, dNMB did not appear to improve recovery quality on the first or second postoperative day. Nevertheless, owing to the low certainty of evidence, well-designed, large-scale RCTs are still needed to validate these results.