Trial reportBMC anesthesiology2026
Low dose of sugammadex versus neostigmine for reversal of rocuronium induced moderate neuromuscular block: a randomized controlled trial.
Trial report in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05718934 (A Randomized Clinical Study to Compare Low Dose of Sugammadex to Standard Dose of Neostigmine and Glycopyrrolate for the Reversal of Rocuronium Induced Moderate Neuromuscular Block), which is not on this map. Not yet cited in PubMed.
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A Randomized Clinical Study to Compare Low Dose of Sugammadex to Standard Dose of Neostigmine and Glycopyrrolate for the Reversal of Rocuronium Induced Moderate Neuromuscular Block
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11 authors.
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Abstract
backgroundResidual neuromuscular blockade (rNMB) after surgery can lead to complications such as respiratory distress, increased length of hospital stay, and higher healthcare costs. Sugammadex, a selective relaxant-binding agent, has shown efficacy in reversing rocuronium-induced neuromuscular blockade more rapidly than neostigmine. This study aimed to evaluate the effectiveness of a low dose of sugammadex (0.5 mg.kg
methodsThis randomized, double-blind, controlled trial included adult patients undergoing surgery with rocuronium-induced moderate neuromuscular blockade. Participants were randomized to receive either low-dose sugammadex or standard-dose neostigmine with glycopyrrolate at the end of surgery. The primary outcome was the time to achieve a Train-of-Four (TOF) ratio of ≥ 0.9 after administration of the reversal agent. Secondary outcomes included extubation time, incidence of sugammadex rescue therapy for incomplete reversal, and postoperative complications. Statistical analysis used t-tests and Mann-Whitney-Wilcoxon tests for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05.
resultsThe median time to reach TOF ratio of ≥ 0.9 was significantly shorter in the sugammadex group (4.3 min, IQR: 3.2-6) compared to the neostigmine group (20.6 min, IQR: 10.1-21.3, p < 0.001). Extubation times were also reduced with sugammadex, with a median of 11.6 (IQR: 8.6-15.1) minutes versus 25.9 (IQR: 17.7-29.7) minutes in the neostigmine group (p < 0.001). Only 4.8% of patients in the sugammadex group required rescue therapy to reverse the neuromuscular block with TOF ratio of ≥ 0.9, compared to 60.6% in the neostigmine group (p < 0.001). No significant differences were observed in postoperative respiratory complications or PACU length of stay.
conclusionsLow-dose sugammadex provides a faster and more reliable reversal of moderate neuromuscular blockade than standard-dose neostigmine, with implications for improved operating room efficiency and patient safety. Continuous neuromuscular monitoring remains essential, as a small proportion of patients may still require additional intervention.
trial registrationRegistered retrospectively at ClinicalTrials.gov with registration number NCT05718934 on 2023-02-08.
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