Reversal of Rocuronium Induced Muscle Relaxation with Sugammadex versus Neostigmine in Patients Undergoing General Anaesthesia: A Randomised Controlled Trial

Abstract

Introduction: Prolonged effects of neuromuscular blocking medications can lead to complications after surgery or the risk of Postoperative Residual Curarisation (PORC) in the postanaesthesia care unit, which may increase morbidity in surgical patients. To enhance patient safety and comfort, it is essential to completely reverse Neuromuscular Blockade (NMB) before transferring the patient to the Postanaesthesia Care Unit (PACU). Aim: The aim of this study is to compare neostigmine with sugammadex for the reversal of rocuronium-induced muscle relaxation in patients undergoing general anaesthesia. Materials and Methods: This randomised controlled study was conducted in patients undergoing general anaesthesia in Department of Anaesthesiology, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India, over a period of one year from 1st August 2023 to 31st July 2024. In this randomised controlled study, a total of 98 adult patients of either sex undergoing surgery under general anaesthesia were enrolled and assigned to two groups of 49 each. The patients were reversed with either of the drugs when the Train-of-Four (TOF) ratio reached 40%. group 1 received Inj. sugammadex 2 mg/kg intravenously (i.v), while group 2 received Inj. neostigmine 0.05 mg/kg with Inj. glycopyrrolate 0.01 mg/kg intravenously at the completion of surgery. Once the TOF stimulation reached 90%, the patient was extubated. The time taken to reach the TOF value from 40% to 90% was recorded. Patients were then transferred to the PACU, monitored for any adverse effects, and discharged from the PACU at an Aldrete score of ≥9 to the respective ward. Categorical data were analysed using the Chi-square test, while quantitative data were analysed using the Student t-test. Results: A total of 98 adult patients were included in the present study. The demographic parameters (age, gender, weight, American Society of Anaesthesiologists (ASA) physical status I and II) were comparable between the two groups (p>0.05). The mean time taken to achieve TOF 40-90% was 2.29±1.12 minutes in group 1 and 8.72±1.5 minutes in group 2, respectively (p<0.01). In the study following extubation, none of the patients in either group exhibited any signs of PORC in the PACU. Significant changes in Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Mean Arterial Pressure (MAP) were observed post-extubation at 0, 5, and 10 minutes (p<0.05). group 1 had a lower incidence of postoperative nausea compared to group 2 (p<0.05). Conclusion: The study concluded that sugammadex reverses rocuronium-induced muscle relaxation faster and more effectively, with fewer haemodynamic changes and adverse effects compared to the neostigmine-glycopyrrolate combination. Thus, its use can be advantageous in cases involving difficult airways, patients with respiratory co-morbidities, and those with limited myocardial reserve, where even a small increase in HR could be detrimental.

Keywords

• curarisation postoperative residual
• glycopyrrolate
• neuromuscular blockade
• neuromuscular monitoring