A retrospective cohort study of the effect of sugammadex versus neostigmine on postoperative gastrointestinal motility in open colorectal surgical procedures

Introduction: Neuromuscular blockers (NMB) are used in surgical procedures to facilitate muscle relaxation and intubation. NMBs are then reversed at the end of the surgery with either an acetylcholinesterase inhibitor, such as neostigmine, or a modified cyclodextrin compound, such as sugammadex. Neostigmine and glycopyrrolate elicit counteracting cholinergic effects, potentially impairing postoperative gastrointestinal motility. This may have higher significance in colorectal surgery procedures given the baseline risk of delayed postoperative motility associated with some operations. Methods: This is a retrospective, single-center, cohort review of open colorectal procedures that received either sugammadex alone, or neostigmine with glycopyrrolate. The primary outcome was time from end of colorectal procedure to time of first bowel movement. Secondary outcomes included incidence of postoperatively placed nasogastric tubes, nausea and vomiting, need for motility agents or TPN, hospital length of stay, 30-day hospital readmission or return to emergency department (ED). Results: A total of 99 patients were included in the sugammadex group and 350 in the neostigmine + glycopyrrolate group. Time to first bowel movement was significantly faster in the sugammadex group (61.7 h) compared to the neostigmine group (71.9 h) (p = 0.03). Secondary outcomes were similar between the two groups, except for a higher incidence of postoperative nausea and vomiting in the sugammadex group (p = 0.04). Discussion: These findings support that sugammadex may be utilized for open colorectal procedures to aid in earlier discharge which could lead to differences in length of stay. Using sugammadex did not result in patients requiring additional interventions or experiencing symptoms of post-operative ileus. Conclusion: Compared to neostigmine and glycopyrrolate, patients receiving sugammadex for neuromuscular blockade reversal in open colorectal procedures experienced a shorter time to return of bowel function. The results from this study confirm the findings from previous retrospective studies that were conducted.