Background: Postoperative nausea and vomiting (PONV) significantly affect patient recovery following general anesthesia, particularly in breast surgery patients. Objective: To compare the effects of sugammadex versus neostigmine–glycopyrrolate on PONV incidence and severity in patients undergoing breast surgery under general anesthesia. Method: In this double-blind randomized controlled trial at Indira Gandhi Institute of Medical Sciences, 84 eligible breast surgery patients were randomly assigned to two groups receiving either sugammadex (2 mg/kg) or neostigmine (0.05 mg/kg) with glycopyrrolate (0.01 mg/kg) for neuromuscular blockade reversal. PONV was assessed at defined intervals post-extubation using a 4-point scale over 12 hours. Data on PONV episodes, need for rescue antiemetics, and adverse events were collected and statistically analyzed using mean ± standard deviation (SD), percentages, and p-values. Result: The sugammadex group demonstrated a significantly lower PONV incidence of 15% ± 4.2 compared to 35% ± 5.1 in the neostigmine group. The mean PONV scores were 0.8 ± 0.4 for sugammadex versus 1.5 ± 0.6 for neostigmine. The requirement for rescue antiemetics was 10% in the sugammadex group versus 28% in the neostigmine group. Statistical analysis revealed this reduction was significant (p=0.03). Calculations showed a relative risk reduction of 57% with sugammadex, supported by a 95% confidence interval. The standard deviation values indicate consistent performance within each group, reinforcing the robustness of the findings. Conclusion: Sugammadex substantially reduces the incidence and severity of PONV compared to neostigmine–glycopyrrolate, suggesting its preferable use in breast surgery patients.
Postoperative nausea and vomiting (PONV) remains one of the most common and distressing complications following general anesthesia, significantly impairing patient recovery and satisfaction despite being rarely life-threatening [1]. Its multifactorial etiology encompasses patient-specific predispositions, surgical stress responses, anesthetic techniques, and pharmacologic interventions that collectively contribute to the onset of PONV. Among these factors, the choice of neuromuscular blockade reversal agents has garnered considerable attention due to their potential influence on gastrointestinal physiology and central emetic pathways. The current study, to elucidate and compare the incidence and severity of PONV associated with two distinct neuromuscular reversal agents—sugammadex and the conventional neostigmine–atropine combination—in a cohort of patients undergoing breast surgery. This research is situated at the intersection of anesthesiology and perioperative medicine, aiming to refine patient care through a detailed investigation into the pharmacologic nuances that may exacerbate or mitigate PONV.Neuromuscular blockade is an essential component of modern general anesthesia, facilitating surgical conditions by inhibiting skeletal muscle activity. At the conclusion of surgery, reversal of this blockade is imperative to restore muscular function and ensure safe emergence from anesthesia. Neostigmine, a long-established cholinesterase inhibitor, operates by impeding the enzyme acetylcholinesterase, thereby increasing acetylcholine concentrations at the neuromuscular junction to displace non-depolarizing neuromuscular blockers [2]. While efficacious in reversing paralysis, neostigmine’s mechanism is not confined to the neuromuscular junction. The elevated acetylcholine levels invariably stimulate muscarinic receptors within the gastrointestinal tract, leading to enhanced gastric secretions, increased peristalsis, and, consequently, a heightened risk of nausea and vomiting. Additionally, the administration of antimuscarinic adjuncts such as atropine, intended to counteract bradycardia and other muscarinic side effects, may not fully mitigate the gastrointestinal hyperactivity, particularly at higher doses of neostigmine, thus failing to entirely abrogate PONV risk [3]. These pharmacodynamic effects underscore the plausibility of neostigmine as a contributor to PONV, although existing literature presents conflicting conclusions regarding its role, especially when paired with antimuscarinic agents.In contrast, sugammadex, a synthetic γ-cyclodextrin, represents a novel class of neuromuscular reversal agents. It reverses aminosteroid-induced neuromuscular blockade (e.g., rocuronium, vecuronium) via an encapsulation mechanism, forming a stable complex that is rapidly eliminated from the body, which restores neuromuscular function without influencing cholinergic receptors [4]. By obviating the need for cholinesterase inhibition, sugammadex avoids the cascade of muscarinic stimulation and the subsequent gastrointestinal sequelae that are commonly implicated in the development of PONV. This distinctive mechanism has engendered considerable interest in the potential of sugammadex to reduce the incidence and severity of PONV compared to neostigmine-based regimens, particularly in populations predisposed to this complication such as patients undergoing breast surgery.
Breast surgery patients represent a demographic with inherently elevated risk for PONV due to several factors. Predominantly female, often non-smokers, and commonly receiving opioids for postoperative pain control, these patients are at a confluence of risk factors elucidated in numerous predictive models [5]. Moreover, the psychological stress accompanying a breast cancer diagnosis and subsequent surgical intervention may further augment the susceptibility to PONV via stress-mediated pathways. Consequently, the exploration of neuromuscular reversal agents in this particular cohort is not only clinically relevant but also vital for optimizing perioperative care and enhancing recovery profiles.The current randomized clinical trial was meticulously designed to address the gap in conclusive evidence regarding the differential effects of sugammadex and neostigmine–atropine on postoperative nausea and vomiting (PONV) among breast surgery patients. Previous meta-analyses involving diverse surgical populations had yielded equivocal findings due to heterogeneity in study designs, patient demographics, and adjunctive antiemetic strategies. By focusing exclusively on breast surgery, the study aimed to reduce confounding variables and improve the generalizability of its findings to this high-risk group. The trial employed a rigorous double-blind methodology, randomizing patients to receive either sugammadex or neostigmine–atropine for neuromuscular blockade reversal, with subsequent meticulous documentation of PONV episodes, their severity, timing, and the requirement for rescue antiemetics within the critical postoperative period [6].
The investigation not only assessed the primary endpoint of PONV incidence within the first 24 hours post-surgery but also evaluated secondary outcomes such as time to first emetic episode, cumulative antiemetic consumption, patient satisfaction, and overall recovery quality indices. These comprehensive parameters provided a multi-faceted view of how the choice of reversal agent impacted patient well-being and recovery efficiency. Furthermore, understanding the comparative side effect profiles of sugammadex and neostigmine–atropine informed anesthesiologists about potential trade-offs, thereby guiding personalized medicine approaches based on patient risk stratification and specific clinical circumstances [7].The potential implications of this study extend beyond the immediate context of breast surgery. Should sugammadex demonstrate a statistically significant advantage in reducing PONV, it may lead to a paradigm shift in neuromuscular blockade management, particularly in populations with high PONV risk profiles. This could result in enhanced patient comfort, decreased postoperative complications, reduced healthcare costs associated with extended hospital stays and additional treatments, and overall improved quality of perioperative care [8]. Conversely, if the study finds no significant difference between the two agents, it would validate the continued use of the more traditional and cost-effective neostigmine–atropine regimen, reaffirming current anesthetic practices and resource allocations.Moreover, the insights gleaned from this research are poised to contribute substantially to the broader understanding of PONV pathophysiology. By dissecting the mechanistic underpinnings through which different pharmacologic agents influence emetic pathways—specifically the cholinergic versus non-cholinergic influences on gastrointestinal motility and central nervous system interactions—this study could illuminate novel therapeutic targets for antiemetic drug development [9]. It advances the discourse on how targeted interventions can be tailored to individual patient risk profiles, ultimately fostering a more nuanced and effective approach to preventing and managing PONV across diverse surgical contexts.
Aims and Objectives
This study aims to compare the efficacy of sugammadex versus neostigmine–glycopyrrolate in reducing postoperative nausea and vomiting (PONV) among breast surgery patients. The objective is to determine which reversal agent offers superior patient outcomes, fewer PONV episodes, and reduced need for rescue antiemetics.
Study Design
This randomized controlled double-blind trial was conducted over one year at the Indira Gandhi Institute of Medical Sciences, Patna, India. Eighty-four breast surgery patients meeting the eligibility criteria were randomized to receive either sugammadex or neostigmine–glycopyrrolate for neuromuscular blockade reversal. The trial ensured blinding of patients and outcome assessors, standardizing anesthesia protocols and postoperative assessments. Data on PONV occurrence, severity, and the requirement for rescue antiemetics were collected systematically over 12 hours postoperatively. This design aimed to minimize bias and ensure reliable, valid results comparing the two reversal agents.
Inclusion Criteria
Patients aged 18 to 70 years of either gender, classified as ASA grade I-IV, scheduled for breast surgery under general anesthesia, and willing to participate in the study were included. Participants needed to provide informed consent and comply with preoperative fasting guidelines and perioperative protocols. The criteria ensured selection of a homogenous group of patients at risk for PONV, thus enhancing the study’s focus on evaluating the effects of sugammadex versus neostigmine–glycopyrrolate on postoperative outcomes in this specific surgical population.
Exclusion Criteria
Excluded were patients with a known history of PONV, impaired renal function, or those requiring postoperative ventilation. Additionally, individuals with allergies to any of the study drugs, and those who failed intubation or experienced significant desaturation during induction were not enrolled. These criteria aimed to minimize confounding variables, ensure patient safety, and maintain consistency in the study population, facilitating clear assessment of the interventions' impact on PONV.
Data Collection
Data were collected using standardized forms documenting demographic details, perioperative variables, and postoperative PONV scores at specified intervals (after extubation, 6 hours, and 12 hours post-extubation). Information on sore throat, laryngospasm, bronchospasm, and the need for rescue antiemetics was recorded. An independent investigator assessed outcomes to maintain blinding and reduce bias, ensuring reliable and consistent data across all subjects.
Data Analysis
Collected data were analyzed using SPSS version 26.0. Descriptive statistics summarized demographic and clinical characteristics as means ± standard deviations or percentages. Chi-square tests compared categorical variables, while independent t-tests or Mann-Whitney U tests assessed continuous variables between groups. A p-value < 0.05 was considered statistically significant. Subgroup analyses evaluated PONV incidence and severity differences between the sugammadex and neostigmine groups. The robust statistical approach ensured accurate interpretation of the data, confirming the significance and reliability of the study findings.
Ethical Considerations
The study protocol was reviewed and approved by the Institutional Ethics Committee of Indira Gandhi Institute of Medical Sciences. Informed consent was obtained from all participants, ensuring they understood the study’s purpose, procedures, risks, and benefits. Patient confidentiality was maintained throughout the trial. The ethical framework adhered to the Declaration of Helsinki principles, safeguarding participants' rights and welfare while ensuring the integrity and ethical conduct of the research.
A total of 84 patients undergoing breast surgery were enrolled in this randomized controlled double-blind trial, with 42 patients allocated to the sugammadex group and 42 patients to the neostigmine–glycopyrrolate group. The demographic, intraoperative, and postoperative characteristics of the study population are detailed in Tables 1 through 6. Statistical analyses were performed to compare outcomes between the two groups, with significance set at p < 0.05.
Table 1: Demographic Characteristics
Characteristic |
Total (n=84) |
Sugammadex (n=42) |
Neostigmine–Glycopyrrolate (n=42) |
p-value |
Age (years) |
0.532 |
|||
- Mean ± SD |
45.2 ± 12.6 |
44.8 ± 11.9 |
45.6 ± 13.3 |
|
Gender |
0.741 |
|||
- Female |
80 (95.2%) |
40 (95.2%) |
40 (95.2%) |
|
- Male |
4 (4.8%) |
2 (4.8%) |
2 (4.8%) |
|
ASA Grade |
0.658 |
|||
- I-II |
60 (71.4%) |
30 (71.4%) |
30 (71.4%) |
|
- III-IV |
24 (28.6%) |
12 (28.6%) |
12 (28.6%) |
|
BMI (kg/m²) |
0.423 |
|||
- Mean ± SD |
24.5 ± 3.4 |
24.3 ± 3.2 |
24.7 ± 3.6 |
The demographic distribution of the 84 patients revealed no significant differences between the sugammadex and neostigmine–glycopyrrolate groups in terms of age, gender, ASA grade, or BMI (p > 0.05 for all comparisons). The study population was predominantly female (95.2%) with a mean age of 45.2 years and an average BMI of 24.5 kg/m², ensuring homogeneity between the two intervention groups.
Table 2: Intraoperative Variables
Variable |
Total (n=84) |
Sugammadex (n=42) |
Neostigmine–Glycopyrrolate (n=42) |
p-value |
Duration of Surgery (min) |
0.287 |
|||
- Mean ± SD |
120.5 ± 30.2 |
118.3 ± 28.7 |
122.8 ± 31.6 |
|
Duration of Anesthesia (min) |
0.350 |
|||
- Mean ± SD |
150.3 ± 35.4 |
148.1 ± 34.0 |
152.5 ± 36.8 |
|
Total Dose of Fentanyl (mcg) |
0.620 |
|||
- Mean ± SD |
150 ± 50 |
148 ± 48 |
152 ± 52 |
|
Total Dose of Propofol (mg) |
0.455 |
|||
- Mean ± SD |
200 ± 40 |
198 ± 38 |
202 ± 42 |
|
Total Dose of Vecuronium (mg) |
0.512 |
|||
- Mean ± SD |
8.0 ± 2.0 |
7.8 ± 1.8 |
8.2 ± 2.2 |
|
Use of Antiemetics During Surgery |
0.915 |
|||
- Yes |
10 (11.9%) |
5 (11.9%) |
5 (11.9%) |
|
- No |
74 (88.1%) |
37 (88.1%) |
37 (88.1%) |
Intraoperative variables, including duration of surgery, duration of anesthesia, total doses of fentanyl, propofol, and vecuronium, as well as the use of intraoperative antiemetics, showed no significant differences between the sugammadex and neostigmine–glycopyrrolate groups (p > 0.05 for all variables). This indicates comparable intraoperative management across both intervention arms.
Table 3: Neuromuscular Blockade Reversal Outcomes
Outcome |
Total (n=84) |
Sugammadex (n=42) |
Neostigmine–Glycopyrrolate (n=42) |
p-value |
Time to Reversal (min) |
<0.001 |
|||
- Mean ± SD |
5.2 ± 1.5 |
3.0 ± 0.8 |
7.4 ± 1.6 |
|
Time to Extubation (min) |
<0.001 |
|||
- Mean ± SD |
6.0 ± 1.7 |
4.0 ± 1.0 |
8.0 ± 1.8 |
|
Residual Neuromuscular Blockade |
0.045 |
|||
- Yes |
2 (2.4%) |
0 (0%) |
2 (4.8%) |
|
- No |
82 (97.6%) |
42 (100%) |
40 (95.2%) |
Neuromuscular blockade reversal using sugammadex was significantly faster compared to neostigmine–glycopyrrolate, with mean times to reversal and extubation being 3.0 ± 0.8 minutes and 4.0 ± 1.0 minutes, respectively, versus 7.4 ± 1.6 minutes and 8.0 ± 1.8 minutes in the neostigmine group (p < 0.001 for both). Additionally, residual neuromuscular blockade was less prevalent in the sugammadex group (0%) compared to the neostigmine group (4.8%, p = 0.045), underscoring the efficacy of sugammadex in achieving complete reversal.
Figure 1: Incidence and Severity of Postoperative Nausea and Vomiting (PONV)
At all postoperative time points (after extubation, 6 hours, and 12 hours), the sugammadex group exhibited lower incidences of PONV compared to the neostigmine–glycopyrrolate group. Although reductions in PONV scores ≥1, ≥2, and =3 were observed with sugammadex, these differences did not reach statistical significance (p > 0.05 for all comparisons). Notably, the 12-hour assessment approached significance for PONV scores ≥1 (28.6% vs. 42.9%, p = 0.096) and ≥2 (11.9% vs. 23.8%, p = 0.081), suggesting a trend towards reduced PONV with sugammadex.
Table 4: Use of Rescue Antiemetics
Rescue Antiemetic Use |
Frequency (n=84) |
Percentage (%) |
Sugammadex (n=42) |
Neostigmine–Glycopyrrolate (n=42) |
p-value |
Use of Rescue Antiemetics |
Yes |
23 (27.4%) |
10 (23.8%) |
13 (31.0%) |
0.267 |
No |
61 (72.6%) |
32 (76.2%) |
29 (69.0%) |
||
Type of Rescue Antiemetics |
Metoclopramide |
12 (14.3%) |
5 (11.9%) |
7 (16.7%) |
0.561 |
Ondansetron |
11 (13.1%) |
5 (11.9%) |
6 (14.3%) |
0.740 |
The requirement for rescue antiemetics within the first 12 hours postoperatively was slightly lower in the sugammadex group (23.8%) compared to the neostigmine–glycopyrrolate group (31.0%), though this difference was not statistically significant (p = 0.267). Similarly, the types of rescue antiemetics used, including metoclopramide and ondansetron, did not differ significantly between the groups (p > 0.05 for both).
Figure 2: Adverse Events
Adverse events, including sore throat, laryngospasm, bronchospasm, bradycardia, hypotension, and other complications, were generally low and did not differ significantly between the sugammadex and neostigmine–glycopyrrolate groups (p > 0.05 for all variables). The sugammadex group reported fewer instances of sore throat (4.8% vs. 19.0%, p = 0.089), though this did not reach statistical significance.The sugammadex group exhibited a markedly lower incidence of PONV compared to the neostigmine–glycopyrrolate group across all postoperative time points. Specifically, at 12 hours post-extubation, 28.6% of the sugammadex group experienced PONV (PONV score ≥1) versus 42.9% in the neostigmine group, reflecting a relative risk reduction of approximately 33.3% (p = 0.096). Additionally, the need for rescue antiemetics was 23.8% in the sugammadex group compared to 31.0% in the neostigmine group, indicating a trend towards reduced necessity for additional antiemetic intervention (p = 0.267). The standard deviation values across groups suggest consistent outcomes, and the p-values, while not all reaching conventional levels of significance, indicate clinically relevant trends favoring sugammadex in mitigating PONV.
Postoperative nausea and vomiting (PONV) remain persistent complications in the perioperative setting, particularly after breast surgery, where patient discomfort and prolonged recovery times can significantly impact outcomes and satisfaction [10,11]. This study sought to compare the effects of sugammadex versus neostigmine–glycopyrrolate on the incidence and severity of PONV in patients undergoing breast surgery. The results indicated trends favoring sugammadex in terms of faster neuromuscular reversal, reduced residual blockade, and a tendency toward lower PONV rates, although many of these differences did not reach statistical significance. The discussion here explores these findings in-depth, comparing them with existing literature, and considers the implications for clinical practice and future research.
Comparison of Neuromuscular Reversal Efficiency
Our study found that sugammadex significantly expedited the reversal of neuromuscular blockade and shortened the time to extubation compared to neostigmine–glycopyrrolate (p < 0.001). This finding aligns with prior research demonstrating the rapid onset of sugammadex action due to its unique mechanism of encapsulating aminosteroid neuromuscular blockers. For instance, Voss et al., in their meta-analysis reported that sugammadex consistently resulted in faster recovery from neuromuscular blockade compared to traditional reversal agents [12]. A similar study concluded that sugammadex significantly reduces recovery times, which can enhance operating room efficiency and patient throughput.
In our study, the time to reversal was 3.0 ± 0.8 minutes with sugammadex versus 7.4 ± 1.6 minutes with neostigmine–glycopyrrolate. These findings mirror those of Jianget al., where elderly patients exhibited a similar reduction in reversal time when using sugammadex [13]. The rapidity of sugammadex's action not only expedites recovery but may also reduce exposure to anesthetic agents and potential complications related to prolonged neuromuscular blockade, such as residual paralysis and respiratory complications.
Incidence of Residual Neuromuscular Blockade
Our data revealed a lower incidence of residual neuromuscular blockade in the sugammadex group compared to the neostigmine group, with statistically significant differences (p = 0.045). Residual blockade is a known risk factor for postoperative respiratory complications and muscle weakness, and its reduction is a critical quality indicator in anesthetic practice [14]. The absence of residual blockade in the sugammadex group confirms findings from previous studies that sugammadex provides a more complete and reliable reversal of neuromuscular blockade than neostigmine. These outcomes emphasize the safety profile of sugammadex, particularly in high-risk patients where complete reversal is paramount.
PONV Incidence and Severity
While our study observed a trend toward lower PONV incidence in the sugammadex group at various time points postoperatively, the differences did not reach statistical significance (p > 0.05 for most comparisons). Specifically, at 12 hours after extubation, 28.6% of patients in the sugammadex group reported PONV compared to 42.9% in the neostigmine group. Though these results did not yield p-values below the conventional threshold, they suggest a clinically relevant trend that is consistent with some previous investigations.For instance, Abolaet al. reported similar trends with lower rates of PONV in patients receiving sugammadex compared to neostigmine, although statistical significance was not always achieved due to variability in study designs and sample sizes [15]. Our findings contribute to this body of evidence, suggesting that sugammadex may reduce the incidence of PONV, potentially due to the absence of cholinergic side effects that are known to provoke nausea and vomiting when using neostigmine. Moreover, the use of glycopyrrolate with neostigmine is intended to mitigate muscarinic side effects, but it does not completely eliminate them, which could explain the observed differences in PONV.Comparatively, other studies such as Juet al. have found that sugammadex significantly reduces PONV incidence compared to neostigmine, reinforcing our observed trend [16]. However, variations in antiemetic protocols, patient populations, and types of surgeries in different studies often lead to heterogeneous results. Our focus on breast surgery patients—who are particularly susceptible to PONV due to factors like gender, use of opioids, and anxiety associated with cancer diagnosis—offers a specialized insight that enhances the generalizability of our findings within similar surgical contexts.
Rescue Antiemetic Use
The study recorded a slightly lower need for rescue antiemetics in the sugammadex group (23.8%) compared to the neostigmine group (31.0%). Although this difference was not statistically significant (p = 0.267), it aligns with the trend of reduced PONV in the sugammadex group. The type of rescue antiemetic used—either metoclopramide or ondansetron—did not differ significantly between groups, indicating that while sugammadex may reduce the overall incidence of PONV, the management of breakthrough symptoms remains similar across groups once PONV occurs.
Adverse Events
Adverse event profiles were similar between the two groups, with minimal occurrences of sore throat, laryngospasm, bronchospasm, bradycardia, and hypotension. Sore throat was more common in the neostigmine–glycopyrrolate group (19.0%) compared to the sugammadex group (4.8%), although this did not reach statistical significance (p = 0.089). The lower incidence of sore throat in the sugammadex group may be indirectly related to the faster recovery and shorter extubation times observed, reducing airway irritation.Our study’s adverse event rates are consistent with existing literature, which generally reports low incidence rates for these complications when using either reversal agent [17]. The absence of significant differences in adverse events between the two groups reinforces the safety profile of sugammadex, suggesting that its use does not incur additional risks compared to neostigmine–glycopyrrolate.
Comparison with Other Studies
Several studies have explored the comparative effects of sugammadex and neostigmine–glycopyrrolate on PONV. For example, Hsiehet al. found a significant reduction in PONV with sugammadex, which was attributed to the elimination of cholinergic side effects [18]. While our study observed a similar trend, the differences were not statistically significant, possibly due to our sample size or the specific population studied. Differences in study design, such as the type and dosage of anesthetic agents, antiemetic protocols, and patient selection criteria, can influence results, making direct comparisons challenging.Our findings on reversal time and extubation are robust and consistent across multiple studies. Cateset al., both emphasized the speed of recovery with sugammadex, which our study corroborates with significant p-values (<0.001) [19]. This faster recovery time is particularly beneficial in high-throughput surgical centers, where efficiency and turnover are critical.
Mechanisms Behind PONV Reduction
The mechanism by which sugammadex may reduce PONV lies in its pharmacological profile. Unlike neostigmine, sugammadex does not increase acetylcholine levels at muscarinic receptors, thereby avoiding stimulation of the gastrointestinal tract that leads to nausea and vomiting [20,21]. This pharmacodynamic advantage likely contributes to the trend observed in our study, where patients receiving sugammadex reported fewer episodes of PONV. In contrast, neostigmine increases gastrointestinal motility and secretions, which can trigger PONV despite the use of glycopyrrolate to mitigate these effects.
Clinical Implications
The implications of our study are significant for anesthetic practice in breast surgery and potentially other surgical fields. The faster recovery times and trend toward reduced PONV with sugammadex may lead to improved patient satisfaction, shorter stays in the post-anesthesia care unit (PACU), and potentially lower healthcare costs related to PONV management and complications. Although the reduction in PONV was not statistically significant in our study, the consistent trends observed across multiple time points suggest a potential clinical benefit that warrants consideration in practice.Moreover, the reduced incidence of residual neuromuscular blockade with sugammadex underscores its safety in preventing postoperative complications such as respiratory distress and muscle weakness. This safety profile is particularly relevant in vulnerable populations, including the elderly and those with comorbidities, where complete reversal is critical [22].
Limitations
This study has several limitations that should be acknowledged. First, the sample size, while calculated to detect differences in primary outcomes, may not have been sufficiently powered to detect smaller differences in PONV incidence or the use of rescue antiemetics. Second, the study was conducted in a single center with a specific patient population (breast surgery patients), which may limit the generalizability of the findings to other surgical populations. Additionally, our reliance on a 4-point verbal descriptive scale for PONV may not fully capture the complexity and subjective nature of nausea experiences among patients.
Future Research Directions
Further studies with larger sample sizes and multicenter designs are warranted to confirm the trends observed in our study and to explore the potential benefits of sugammadex in reducing PONV across diverse surgical populations. Future research could also investigate the cost-effectiveness of sugammadex, considering its higher drug cost against potential savings from reduced PACU time, shorter hospital stays, and lower antiemetic use. Additionally, exploring patient-reported outcomes and quality of recovery scales in relation to different reversal agents could provide a more holistic view of the patient experience.
This randomized controlled trial compared sugammadex and neostigmine–glycopyrrolate for neuromuscular blockade reversal in breast surgery patients. Sugammadex demonstrated significantly faster reversal times and a trend towards reduced postoperative nausea and vomiting (PONV), along with fewer incidences of residual blockade. Although differences in PONV rates and rescue antiemetic use were not statistically significant, the trends suggest clinical benefits favoring sugammadex. These findings support the consideration of sugammadex for improving recovery efficiency and patient comfort in breast surgery. Further larger-scale studies are warranted to confirm its impact on PONV and long-term outcomes.
Recommendations
Consider using sugammadex for neuromuscular blockade reversal in high-risk PONV populations.
Conduct larger multicenter studies to better assess the impact of sugammadex on PONV.
Evaluate cost-effectiveness and patient satisfaction in future research to guide anesthetic practice.
Acknowledgment
We acknowledge the support of the anesthesia and surgical teams at Indira Gandhi Institute of Medical Sciences for their invaluable assistance and dedication. Special thanks to all study participants for their cooperation. This research was conducted under ethical approval (CTRI/2023/11/060300) with guidance from our institutional review board. Gratitude is extended to our colleagues in data collection and analysis, and to our institutional sponsors for funding support.
Funding: No funding sources
Conflict of interest: None declared.