Residual neuromuscular blockade after general anaesthesia contributes to adverse patient outcomes and increased healthcare costs. Using objective (quantitative) neuromuscular monitoring to guide and confirm appropriate reversal prior to tracheal extubation is strongly recommended. However, uptake of this evidence-based practice is very poor.
The Goal-directed Objective Paralysis Reversal Outcomes (GOPRO) Trial is a multi-centre, batched stepped-wedge cluster randomised trial comparing routine practice with a goal-directed approach that combines objective neuromuscular monitoring and pharmacological reversal to achieve a train-of-four ratio ≥ 0.9. As a hybrid effectiveness-implementation trial, the GOPRO trial will not only evaluate the clinical intervention, but also the implementation strategies for promoting its uptake into clinical practice.
Implementation science is critical to bridging the evidence-to-practice gap in anaesthesia and perioperative medicine. By addressing individual, organisational and system-level barriers, the GOPRO trial aims to engage clinicians as key drivers of change and achieve sustainable adoption of evidence-based practices to improve patient safety in the real world.
This trial will form part of Dr Sophie Liang’s PhD at the University of Sydney, which focuses on improving the translation and implementation of research evidence in anaesthesia and perioperative medicine. She is also supported by a National Health and Medical Research Council (NHMRC) Postgraduate Scholarship.
Dr Sophie Liang, Dr Brenton Sanderson, Westmead Hospital, Dr Mitchell Sarkies, Professor Melissa Baysari, Dr Kristy Robledo, University of Sydney, Dr Oya Gumuskaya, Western Sydney University, Dr Ben Olesnicky, Royal North Shore Hospital, A/Prof Justin Skowno, Children’s Hospital at Westmead, Prof Paul Stewart, Australian National University, Dr Wade Weigel, University of North Carolina, USA.
The project was awarded A$89,906 funding through the ANZCA research grants program for 2026.