- Visibility 617 Views
- Downloads 566 Downloads
- Permissions
- DOI 10.18231/j.ijca.2025.076
-
CrossMark
Comparison of efficacy and safety profile of sugammadex versus neostigmine for reversal of rocuronium induced neuromuscular blockade in elective lumbar spine surgeries: A prospective randomized controlled trial
- Author Details:
-
Amit Pravin Chauhan *
-
Mitanshi Jain
-
Jigisha Mehta
-
Tejash Sharma
-
Charmi Shah
-
Sara Mary Thomas
Amit Pravin Chauhan *
Mitanshi Jain
Jigisha Mehta
Tejash Sharma
Charmi Shah
Sara Mary Thomas
Background and Aim: Effective reversal of neuromuscular blockade is essential to prevent postoperative complications such as residual paralysis and respiratory distress. Neostigmine has long been used for this purpose, but its side effects and slower onset have prompted interest in alternatives like Sugammadex. This study assessed the effectiveness and safety of Sugammadex (2 mg/kg) compared to Neostigmine (50 ?g/kg) in reversing rocuronium-induced neuromuscular blockade in patients undergoing planned lumbar spine surgery under neurosurgical anesthesia in India. The research focused on evaluating the reversal capabilities of these two agents in this specific clinical setting.
Materials and Methods: This prospective, randomized controlled trial included 80 patients (ASA Class 1–3) who were administered rocuronium (1.2 mg/kg) for endotracheal intubation, with supplemental doses given as required. Neuromuscular blockade (NMB) was assessed using train-of-four (TOF) monitoring. Upon reappearance of the second twitch, participants were randomly allocated to receive either Sugammadex or neostigmine with glycopyrrolate. The primary outcome measure was the recovery time required for the TOF ratio to reach 0.9.
Results: Patients receiving sugammadex had a geometric mean recovery time of 1.85 minutes (95% CI: 1.5–2.1), compared to 5.88 minutes (95% CI: 2.9–8.9) for neostigmine. Sugammadex was well tolerated, with no serious adverse events or instances of residual or recurrent NMB noted.
Conclusion: Sugammadex facilitated a significantly faster recovery from NMB than neostigmine, achieving recovery approximately three times quicker in the studied population. It was well tolerated, with no serious adverse events, and demonstrated a favourable safety profile in this clinical setting.
Keywords: Neostigmine; Neuromuscular blockade; Neuromuscular blocking agents; Neuromuscular blockade reversal; Rocuronium; Sugammadex; TOF ratio.
References
- Williams B. A systematic review comparing neostigmine versus sugammadex [master’s thesis]. Rhode Island College; 2019. Available from: https://digitalcommons.ric.edu/etd/321
- Fiorda Diaz J, Echeverria-Villalobos M, Esparza Gutierrez A, Dada O, Stoicea N, Ackermann W, et al. Sugammadex versus neostigmine for neuromuscular blockade reversal in outpatient surgeries: a randomized controlled trial to evaluate efficacy and associated healthcare cost in an academic center. Front Med. 2022;9:1072711.
- Wu X, Oerding H, Liu J, Vanacker B, Yao S, Dahl V, et al. Rocuronium blockade reversal with sugammadex vs. neostigmine: randomized study in Chinese and Caucasian subjects. BMC Anesthesiol. 2014;14:53.
- Ali HH, Utting J, Gray C. Stimulus frequency in the detection of neuromuscular block in humans. Br J Anaesth. 1970;42(11):967–78.
- Ammar S, Mahmoud KM, Kasemy ZA. A comparison of sugammadex and neostigmine for reversal of rocuronium-induced neuromuscular blockade in children. Acta Anaesthesiol Scand. 2017;7(2):313–8.
- Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev. 2017;8(8):CD012763.
- Paton F, Paulden M, Chambers D, Heirs M, Duffy S, Hunter J, et al. Sugammadex compared with neostigmine/glycopyrrolate for routine reversal of neuromuscular block: a systematic review and economic evaluation. Br J Anaesth. 2010;105:558–67.
- Deyhim N, Beck A, Balk J, Liebl MG. Impact of sugammadex versus neostigmine/glycopyrrolate on perioperative efficiency. Clinicoecon Outcomes Res. 2020;12:69–79.
- Choi E, Oh A, Koo B, Hwang J, Han J, Seo K, et al. Comparison of reversal with neostigmine of low-dose rocuronium vs. reversal with sugammadex of high-dose rocuronium for a short procedure. Anaesthesia. 2017;72(10):1185–90.
- Lombardi S, Morrison M, Baker W, Martin S. Sugammadex versus neostigmine and the impact on post-anesthesia care unit length of stay. Crit Care Med. 2020;48(1):462.
- Hurford WE, Eckman MH, Welge JA. Data and meta-analysis for choosing sugammadex or neostigmine for routine reversal of rocuronium block in adult patients. Data Brief. 2020;32:106241.
- Sacan O, White PF, Tufanogullari B, Klein K. Sugammadex reversal of rocuronium-induced neuromuscular blockade: a comparison with neostigmine-glycopyrrolate and edrophonium-atropine. Anesth Analg. 2007;104(3):569–74.
- Blobner M, Eriksson LI, Scholz J, Motsch J, Della Rocca G, Prins ME. Reversal of rocuronium-induced neuromuscular blockade with sugammadex compared with neostigmine during sevoflurane anaesthesia: results of a randomised, controlled trial. Eur J Anaesthesiol. 2010;27(10):874–81.
- Jones RK, Caldwell JE, Brull SJ, Soto RG. Reversal of profound rocuronium-induced blockade with sugammadex: a randomized comparison with neostigmine. Anesthesiology. 2008;109(8):816–
- 498 Chauhan et al. / Indian Journal of Clinical Anaesthesia 2025;12(3):492–498
- Illman HL, Laurila P, Antila H, Meretoja O, Alahuhta S, Olkkola KT. The duration of residual neuromuscular block after administration of neostigmine or sugammadex at two visible twitches during train-of-four monitoring. Anesth Analg. 2011;112(1):63–8.
- Geldner G, Niskanen M, Laurila P, Mizikov V, Hubler M, Beck G, et al. A randomised controlled trial comparing sugammadex and neostigmine at different depths of neuromuscular blockade in patients undergoing laparoscopic surgery. Anaesthesia. 2012;67(9):991–8.
- Grintescu I, Mirea L, Ologoiu D, Ungureanu R, Mekauvar S, Vasilescu M. Comparison of the cost-effectiveness of sugammadex and neostigmine during general anaesthesia for laparoscopic cholecystectomy. Br J Anaesth. 2009;103(6):917.
- Woo T, Kim KS, Shim YH, Kim MK, Yoon SM, Lim YJ, et al. Sugammadex versus neostigmine reversal of moderate rocuronium- induced neuromuscular blockade in Korean patients. Korean J Anesthesiol. 2013;65(6):501–7.
- Chazot T, Dumont G, Le Guen M, Hausser-Hauw C, Liu N, Fischler M. Sugammadex administration results in arousal from intravenous anaesthesia: a clinical and electroencephalographic observation. Br J Anaesth. 2011;106(6):914–6.
- Lanier WL. The afferentation theory of cerebral arousal. In: Johnson JO, Sperry RJ, Stanley TH, editors. Neuroanesthesia. Developments in Critical Care Medicine and Anesthesiology. Vol. 32. Dordrecht: Springer; 1997.
- Khuenl-Brady KS, Wattwil M, Vanacker BF, Lora-Tamayo JI, Rietbergen H, Álvarez-Gómez JA. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg. 2010;110(1):64–73.
- Chang HC, Liu SY, Lee MJ, Lee SO, Wong CS. Sugammadex reversal of muscle relaxant blockade provided less post-anesthesia care unit adverse effects than neostigmine/glycopyrrolate. J Formos Med Assoc. 2022;121(12):2639–43.
- Hunter J. Reversal of residual neuromuscular block: complications associated with perioperative management of muscle relaxation. Br J Anaesth. 2017;119:i53–62.
- Srivastava A, Hunter J. Reversal of neuromuscular block. Br J Anaesth. 2009;103(1):115–29.
- Luo J, Chen S, Min S, Peng L. Reevaluation and update on efficacy and safety of neostigmine for reversal of neuromuscular blockade. Ther Clin Risk Manag. 2018;14:2397–2406.
- Yağan Ö, Taş N, Mutlu T, Hancı V. Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting. Braz J Anesthesiol. 2017;67(2):147–52.
- Verhamme KM, Sturkenboom MC, Stricker BHC, Bosch R. Drug- induced urinary retention. Drug Saf. 2008;31(5):373–88.
- Cha JE, Park SW, Choi YI, Oh ID, Kang HY, Lee SH, et al. Sugammadex use can decrease the incidence of post-operative urinary retention by avoiding anticholinergics: a retrospective study. Anesth Pain Med. 2018;13(1):40–6.
- Nag K, Singh DR, Shetti AN, Kumar H, Sivashanmugam T, Parthasarathy S. Sugammadex: a revolutionary drug in neuromuscular pharmacology. Anesth Essays Res. 2013;7(3):302–6.
- Cada DJ, Levien TL, Baker DE. Sugammadex. Hosp Pharm. 2016;51(7):585–96.
- Keating GM. Sugammadex: a review of neuromuscular blockade reversal. Drugs. 2016;76(10):1041–52.
- Pühringer FK, Rex C, Sielenkämper AW, Claudius C, Larsen PB, Prins ME, et al. Reversal of profound, high-dose rocuronium- induced neuromuscular block by sugammadex at two different time points: an international, multicenter, randomized, dose-finding, safety assessor–blinded, phase II trial. Anesthesiology. 2008;109(2):188–97.
- Bhavani S. Severe bradycardia and asystole after sugammadex. Br J Anaesth. 2018;121(1):95–6.