Postoperative Urinary Retention After Reversal of Neuromuscular Block by Neostigmine versus Sugammadex in Patients Undergoing Laparoscopic Cholecystectomy: A Randomized Controlled Trial.

Abstract

In an era of fast-track surgery and enhanced recovery protocols, postoperative urinary retention (POUR) remains a common barrier to same-day discharge, contributing to prolonged PACU stays, patient discomfort, and unplanned admissions. Although sugammadex has been associated with a reduced incidence of POUR, no prospective, randomized studies have compared neostigmine and sugammadex for neuromuscular blockade reversal in laparoscopic cholecystectomy. The objective of this study was to determine the incidence of postoperative urinary retention after the reversal of rocuronium-induced neuromuscular blockade with neostigmine versus sugammadex in patients undergoing laparoscopic cholecystectomy. A total of 235 patients undergoing laparoscopic cholecystectomy were enrolled. Anesthesia was induced with rocuronium 0.6 mg/kg (ideal body weight, IBW) to facilitate intubation, and moderate neuromuscular blockade was maintained intraoperatively with 0.15 mg/kg (IBW) doses. At the end of surgery, patients received either sugammadex 2 mg/kg (total body weight, TBW) or neostigmine 50 to 70 µg/kg (IBW) with glycopyrrolate 8 to 10 µg/kg (IBW) for reversal. Bladder volumes were assessed via ultrasound before and after attempted voiding. Postoperative urinary retention (POUR) was defined as (1) inability to void with bladder volume ≥ 300 mL, (2) post-void residual ≥ 200 mL, or (3) need for catheterization. The incidence of POUR was recorded as the primary end point. The incidence of POUR was significantly lower with sugammadex compared with neostigmine, difference of 12.8% (95% CI of the difference 4% to 22%, P < .001). There were no major adverse events in either group. In patients undergoing laparoscopic cholecystectomy, neuromuscular blockade with rocuronium followed by reversal with sugammadex provides a significant reduction in postoperative urinary retention when compared to reversal with neostigmine, without any major adverse effects.