COMPARISON OF SUGAMMADEX AND NEOSTIGMINE FOR REVERSAL OF ROCURONIUM-INDUCED NEUROMUSCULAR BLOCKADE IN PATIENTS UNDERGOING GENERAL ANAESTHESIA: A RANDOMIZED CONTROLLED TRIAL

Abstract

Materials and Methods: prospective, double-blinded randomized controlled trial (RCT) has been held in 74 adult patients (ASA I–II) undergoing elective surgery under general anaesthesia. Participants have been randomized into 2 groups: sugammadex 2mg/kg (Group S, n=37) and neostigmine 50µg/kg having glycopyrrolate (Group N, n=37). Quantitative neuromuscular monitoring using acceleromyography has been employed. Primary outcome has been time from administration of reversal agent to recovery of train-of-four (TOF) ratio ≥0.9. Secondary outcomes involved time to sustained head lift and hand grip, as well as incidence of postoperative adverse events. Results: Baseline characteristics were comparable between groups, with no significant differences in age (p = 0.556), gender (p = 0.244), procedure duration (p = 0.25), or rocuronium dose (p = 0.29). Sugammadex produced significantly faster recovery: TOF 0.9 at 2.6 ± 1.5 min versus 4.3 ± 1.9 min (p < 0.001).Clinical tests of neuromuscular recovery were in favour of sugammadex :head-lift at 3.0 ± 2.2 min versus 6.2 ± 3.2 min (p < 0.001), and hand-grip at 3.2 ± 2.3 min versus 6.5 ± 3.6 min (p < 0.001)which showed positive correlation with TOF ratio(r = 0.72, p < 0.001). Adverse effects were markedly fewer with sugammadex (10.8% vs. 40.5%, p = 0.003). Conclusion: Sugammadex provides more reliable and faster reversal of rocuronium-induced neuromuscular blockade having earlier clinical recovery and fewer adverse effects compared with neostigmine. It represents a clinically advantageous option for neuromuscular blockade reversal in routine anaesthetic practice.