TOPLINE:

Reversal of neuromuscular blockade with sugammadex in patients undergoing laparoscopic cholecystectomy resulted in a lower incidence of postoperative urinary retention than reversal with neostigmine.

METHODOLOGY:

• Researchers conducted a randomized trial at a hospital in Dallas to compare the incidence of postoperative urinary retention based on neuromuscular blockade reversal agents used.
• They included 230 patients aged 18-80 years who were scheduled for laparoscopic cholecystectomy and had an American Society of Anesthesiologists physical status of I-III.
• Anesthesia was induced with 1.5-2 mg/kg propofol, 50 mg lidocaine, 0.6 mg/kg rocuronium (based on ideal body weight [IBW]), and 0.5-1 μg/kg fentanyl, with additional rocuronium boluses (0.15 mg/kg IBW) administered to maintain a moderate level of neuromuscular blockade.
• Patients were randomly assigned to receive either neostigmine 50-70 μg/kg with glycopyrrolate 8-10 μg/kg (both based on IBW; not exceeding 5 mg and 1 mg, respectively; n = 112; mean age, 41 years) or sugammadex 2 mg/kg (based on total body weight; n = 118; mean age, 40 years) for the reversal of moderate neuromuscular blockade at surgery completion.
• The primary outcome was the incidence of postoperative urinary retention, defined as the inability to void with a bladder volume of ≥ 300 mL, a postvoid residual of at least 200 mL, or the need for catheter insertion, assessed via bladder ultrasound before and after attempted voiding.

TAKEAWAY:

• The incidence of postoperative urinary retention was lower in the sugammadex group than in the neostigmine group (difference in estimates, 0.128; P = .002).
• Reversal with sugammadex was associated with lower odds of postoperative urinary retention (adjusted odds ratio, 0.22; P = .003).
• The mean time to extubation was shorter in the sugammadex group than in the neostigmine group (10 vs 14 minutes; difference, 4 minutes; P < .001); the mean time to post-anesthesia care unit discharge was also shorter (difference, 23 minutes; P = .03).
• In the neostigmine group, four patients were unable to void with a bladder volume of ≥ 300 mL, 15 patients had a postvoid residual of ≥ 200 mL, and one patient required a catheter due to the inability to void 600 mL despite four attempts. No adverse effects or events occurred in either group.

IN PRACTICE:

“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,” the researchers of the study reported.

SOURCE:

The study was led by Callie E. Diesch, BS, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas. It was published online on March 6, 2026, in Anesthesia & Analgesia.

LIMITATIONS:

The enrollment occurred at a single center. The use of qualitative, rather than quantitative, neuromuscular monitoring may have reduced the precision of reversal timing. Three protocol violations resulted in a partial per-protocol analysis.

DISCLOSURES:

The study received partial support through a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. No additional funding was reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.