COMPARISON OF SUGAMMADEX WITH NEOSTIGMINE FOR REVERSAL OF VECURONIUM INDUCED NEUROMUSCULAR BLOCKADE: A RANDOMIZED CONTROLLED TRIAL

Abstract

Introduction: Neuromuscular blocking drugs (NMBDs) are commonly used in anesthesia, but residual neuromuscular blockade (RNMB) post-surgery can lead to serious complications such as hypoxia and airway obstruction. Acetylcholinesterase inhibitors like neostigmine have been traditionally used for reversal, though they come with side effects. Sugammadex, a newer agent, offers faster reversal and fewer complications. This study aims to compare the efficacy and safety of sugammadex with neostigmine in reversing vecuronium-induced neuromuscular blockade and assess associated adverse effects.
Methods: A randomized controlled trial was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun. Sixty patients were enrolled after ethical approval and informed consent. Group A received sugammadex (2 mg/kg), while Group B received neostigmine (0.05 mg/kg). Patients were monitored for reversal time, efficacy, complications, and post-operative recovery. Data were analyzed using statistical methods, including p-values, mean, standard deviation (SD), interquartile range (IQR), and 95% confidence intervals.
Results: In Group A, 93.3% of patients achieved TOF ratio 0.9 in under 10 minutes, compared to 50.0% in Group B. The efficacy of reversal was 93.3% in Group A and 83.3% in Group B. The incidence of post-operative complications was lower in Group A (13.3%) compared to Group B (20.0%). No significant differences were found in ASA classification, age, or surgical duration between the groups. Statistical analysis showed p-values > 0.05 for baseline characteristics, indicating comparability.
Conclusion: Sugammadex is a faster and more effective agent for reversing neuromuscular blockade compared to neostigmine, with a lower incidence of complications. Both drugs showed similar results in hospital stay and ICU admission. Sugammadex is recommended for quicker recovery and fewer adverse effects, enhancing the recovery process in surgical settings.