Effect of neuromuscular blockade reversal strategy on gastrointestinal recovery following abdominal wall reconstruction: a randomized controlled trial

PURPOSE: Evaluate the impact of sugammadex on gastrointestinal recovery following complex AWR. METHODS: This single-center, double-blinded, randomized controlled trial randomized 184 patients undergoing open retromuscular AWR to receive either sugammadex or neostigmine/glycopyrrolate for neuromuscular blockade reversal per drug packaging protocol. The primary outcome was time to gastrointestinal recovery (GI-2), defined as tolerance of solid food and first bowel movement and univariate and multivariate analysis was used to compare sugammadex and neostigmine/glycopyrrolate cohorts. Secondary outcomes included incidence of POI, hospital length of stay, and opioid consumption among our two cohorts. RESULTS: The final analysis included 177 patients (88 sugammadex, 89 neostigmine/glycopyrrolate). Median time to GI-2 recovery was similar between groups (89 vs. 87 h, Wilcoxon rank-sum p = 0.637). No significant differences were observed in POI incidence (21% vs. 25%, p = 0.52) or length of stay (5 vs. 4 days, p = 0.90). Multivariable analysis confirmed sugammadex did not significantly affect time to GI-2 recovery (HR 0.96, 95% CI 0.69-1.32, p = 0.79). Independent predictors of delayed recovery included POI development and greater opioid consumption. CONCLUSIONS: Sugammadex did not result in faster return to gastrointestinal function when compared with neostigmine/glycopyrrolate when used for neuromuscular blockade reversal. Thus, avoidance of neostigmine/glycopyrrolate did not reduce POI incidence or hospital length of stay in patients undergoing complex AWR.