Effects of neuromuscular block reversal with neostigmine/glycopyrrolate versus sugammadex on bowel motility recovery after laparoscopic colorectal surgery: A randomized controlled trial

Study objective: To compare the effects of neostigmine/glycopyrrolate (a traditional agent) and sugammadex on bowel motility recovery and the occurrence of digestive system complications after colorectal surgery. Design: Prospective, randomized controlled trial. Setting: A single tertiary center. Patients: 111 patients undergoing laparoscopic colorectal surgery. Interventions: Patients were randomized into two groups based on the block reversal agent: 1) a mixture of 50 mu g.kg(-1) of neostigmine and 10 mu g.kg-1 of glycopyrrolate (neostigmine group) and 2) 2 mg.kg(-1) of sugammadex (sugammadex group). Measurements: The primary outcome was the time from the surgery's completion to the first flatus. The time to the first postoperative defecation, incidences of postoperative nausea or vomiting, ileus, and dry mouth, as well as postoperative length of stay, were also assessed. Main results: The time to the first flatus was significantly shorter in the sugammadex group than in the neostigmine group (59 [42-79] h vs 69 [53-90] h, P = 0.027). The time to the first defecation and the incidences of postoperative nausea or vomiting and ileus did not differ between the groups, nor did the postoperative length of stay. However, the incidence of postoperative dry mouth was significantly lower in the sugammadex group than in the neostigmine group (7 patients [13%] vs 39 patients [71%], P < 0.001). Conclusions: The time to the first flatus was shorter using 2 mg.kg(-1) sugammadex to reverse the neuromuscular block for laparoscopic colorectal surgery compared to reversal with conventional neostigmine/glycopyrrolate.