Quality of Recovery after Laparoscopic Cholecystectomy Following Neuromuscular Blockade Reversal with Neostigmine or Sugammadex: A Prospective, Randomized, Controlled Trial

Abstract

The risk of neuromuscular blockade is certainly minimized by sugammadex in combination with monitoring. However, the effect of sugammadex-aided recovery on patients’ satisfaction is unclear. This study compared the Quality of Recovery (QoR)-15 score, which is a patient-reported outcome, in patients undergoing laparoscopic cholecystectomy. Eighty patients were randomly assigned to the neostigmine or sugammadex groups. At the end of surgery, neostigmine or sugammadex was administered, and tracheal extubation was performed after confirmation of a train of four ratio ≥ 0.9. The QoR-15 questionnaire was administered at 1 day before surgery and on post-operative days (POD) 1 and 2. The primary outcome was the QoR-15 score on POD 1. The secondary outcomes were the QoR-15 score on POD 2, modified Aldrete score, length of post-anesthetic care unit stay, post-operative pain, administration of anti-emetics, urinary retention, and length of hospital stay. No significant differences were found in QoR-15 scores on POD 1 (94.4 vs. 95.5, p = 0.87) or 2 (116.3 vs. 122, p = 0.33). Secondary outcomes were also comparable, with the exception of urinary retention (15.8% neostigmine vs. 2.6% sugammadex, p = 0.04). This study demonstrated that the quality of recovery was comparable between the neostigmine and sugammadex groups when reversal and tracheal extubation were performed in accordance with the current guidelines.

Transcutaneous Electrical Acupoints Stimulation Improves Spontaneous Voiding Recovery After Laparoscopic Cholecystectomy: A Randomized Clinical Trial

“…# Defined as any partial or full weight-bearing activities conducted 2 to 3 times outside of the ward, with a total walking distance of 250-500 m NRS numerical rating scale, HADS Hospital Anxiety and Depression Scale-Depression, IQR interquartile range, POUR, postoperative urinary retention Values are expressed as numbers (percentages) unless otherwise indicated insertion, and ultrasound assessment to make the assessment more accurate and comprehensive [22]. We screened the patients in our study who fulfilled the diagnostic criteria and found the incidence of POUR was 11.4% in patients in the control group, a finding that is consistent with previous results and provides a reference for the incidence of urinary retention after laparoscopic cholecystectomy [4,5]. The incidence of POUR was significantly reduced to 8.1% after TEAS treatment with statistically significant difference, indicating that TEAS may be an effective approach to reducing the incidence of POUR.…”

“…It is estimated that nearly 700,000 cholecystectomy surgeries are performed annually in the USA [1] and the incidence is increasing in developing countries [2,3]. Urinary retention is one of the major complications after laparoscopic cholecystectomy, affecting 4.7-15.8% patients, and it is associated with prolonged hospital stay, increased costs, and patient anxiety and discomfort [4][5][6].…”

2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: A Report by the American Society of Anesthesiologists Task Force on Neuromuscular Blockade

“…The body of evidence enrolling adults included 191 studies (133 randomized controlled trials, 4,59–90,92,95,98–104,110–114,118–127,132–141,145–148,155–157,163,173–181,206–254 11 nonrandomized trials, 17,128,142,182–184,191,255–258 45 cohort studies, 15,42,86,91,93,94,96,97,105–109,116,117,129–131,143,144,186–190,227,259–277 and 2 before–after designs 115,168 ) evaluating efficacy and safety of antagonist drugs for neuromuscular blockade. The randomized controlled trials enrolling only adults had a median of 88 participants (range, 16 to 350).…”

Urinary Retention After Video-Assisted Thoracoscopic Surgery: Role of Neuromuscular Blockade Reversal

“…Valencia Morales et al 3 reported that the rate of POUR among 181 patients who underwent inguinal hernia repair (75 sugammadex, 106 neostigmine/glycopyrrolate reversals) was 2 (3%) for those reversed with sugammadex and 16 (15%) for those reversed with neostigmine/glycopyrrolate. Han et al 4 studied 77 patients undergoing laparoscopic cholecystectomy (39 sugammadex, 38 neostigmine/glycopyrrolate) and the rate of POUR was 1 (2.6%) for those reversed with sugammadex and 6 (15.8%) for those reversed with neostigmine/glycopyrrolate. The magnitude of difference and rates of POUR in these two studies were similar to the observed in the present study.…”