A single center analysis of sugammadex and neostigmine/glycopyrrolate utilization for post-operative neuromuscular blockade reversal

Background: Previous cost-effective analyses and studies analyzing post-anesthesia care unit length of stay between sugammadex and neostigmine/glycopyrrolate for neuromuscular blockade reversal revealed mixed results. Baseline characteristics between adult surgical patients receiving these agents were controlled and matched in this study to describe these differences in cost and first neuromuscular blocking agent (NMBA) reversal dose to recovery room time.Aim: To evaluate the differences in the time from the first NMBA reversal dose to recovery room arrival between sugammadex and neostigmine/glycopyrrolate. Methods: In this retrospective matched cohort study, 142 adult surgical patients who received sugam-madex were matched to 142 neostigmine/glycopyrrolate adult surgical patients that received at least one dose of rocuronium or vecuronium. The primary outcome was the time from the first NMBA reversal dose to recovery room arrival. Secondary outcomes included: differences in the time from the recovery room to the floor, evaluation of the total cost, and total drug cost. Results: The time from first NMBA reversal dose to recovery room arrival was similar between groups (neostigmine/glycopyrrolate 19.5 min (14-31 min) versus sugammadex 19.0 min (13.8-24.3 min); p = 0.165). The medium time from the recovery room to the floor is 91.0 and 94.5 min in the sugam-madex and neostigmine/glycopyrrolate groups, respectively (p = 0.302). The incidence of reintubation was not statistically different (p = 1.00). The total drug cost was higher in the sugammadex group versus the neostigmine/glycopyrrolate group, $97.00 USD (97-114.48) versus $8.99 USD (6.23-11.52), respec-tively (p < 0.05). However, the medium total cost was $985.32 USD for neostigmine/glycopyrrolate whereas it was $1047.00 USD for sugammadex. Conclusion: The time from the first NMBA reversal dose to recovery room and time from recovery room to the floor were comparable between sugammadex and neostigmine/glycopyrrolate. There were no differences in reintubation rates. While the difference in total drug cost was statistically significant between the two groups, the total cost was not. Further analysis is needed to assess these safety and economic implications of these findings. (C) 2022 Elsevier Ltd. All rights reserved.

Automated summary

This study found no significant difference in time from the first NMBA reversal dose to recovery room between sugammadex and neostigmine/glycopyrrolate. The reintubation rates were similar. However, the total drug cost was significantly higher in the sugammadex group compared to the neostigmine/glycopyrrolate group.