Time Efficiency of Sugammadex versus Neostigmine in Reversing Aminosteroid Neuromuscular Blockade during Laparoscopy: A Prospective Randomized Study

Abstract Background: Rapid, reliable reversal of aminosteroid‑induced neuromuscular blockade (NMB) is critical in laparoscopic procedures to optimize safety and throughput. Traditional reversal with neostigmine is limited by variable efficacy in deep blocks and muscarinic side effects, whereas sugammadex directly encapsulates rocuronium/vecuronium for faster recovery.Objective: To compare the time to complete reversal of NMB—and associated recovery milestones—between sugammadex and neostigmine in elective laparoscopic surgeries.Methods: In this prospective observational study at a tertiary care center, 70 ASA I–II adults undergoing elective laparoscopy were randomized to receive sugammadex (4 mg/kg; n=35) or neostigmine (0.07 mg/kg with anticholinergic; n=35) at surgery end. Primary outcome was time to complete NMB reversal (clinical endpoints). Secondary time‑metrics included time to spontaneous breathing, extubation, and recovery‑room discharge, plus achievement of Modified Aldrete Score ≥9 at 30 minutes. Continuous data were analyzed with independent t‑tests; p < 0.05 considered significant. Results: Sugammadex significantly shortened all recovery intervals: spontaneous breathing (2.01 ± 0.8 vs 6.03 ± 1.01 min, p < 0.001), complete reversal (5.2 ± 1.1 vs 9.8 ± 2.4 min, p < 0.001), extubation (7.3 ± 1.6 vs 14.5 ± 3.9 min, p < 0.001), and recovery‑room discharge (28.4 ± 5.2 vs 35.7 ± 8.9 min, p < 0.001). At 30 min post‑reversal, 97.1% vs 77.1% of sugammadex vs neostigmine patients achieved Aldrete ≥9 (p < 0.001).Conclusions: Sugammadex provides significantly faster and more predictable recovery from aminosteroid NMB than neostigmine, with potential to enhance perioperative efficiency and safety in laparoscopic surgery.