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

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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.