Comparison of Sugammadex and Neostigmine on Speed and Quality of Recovery after Vecuronium Neuromuscular Blockade in Adult Patients Undergoing Spine Surgery under General Anaesthesia: A Randomised Clinical Study
Introduction: Residual neuromuscular blockade after non depolarising muscle relaxants is an important concern during recovery from anaesthesia. Incomplete reversal may affect ventilation, airway protection, and safe extubation. This problem is more relevant in spine surgery, where prolonged anaesthesia, prone positioning, and the need for early neurological assessment make reliable recovery essential. Aim: To compare sugammadex with neostigmine plus glycopyrrolate for reversal of vecuronium-induced neuromuscular blockade in adult patients undergoing elective spine surgery under general anaesthesia. Materials and Methods: This single-blinded randomised clinical study was conducted in the Department of Anaesthesiology, Krishna Hospital and Medical Centre, Krishna Institute of Medical Sciences, Karad, Maharashtra, India, from July 2024 to December 2025. The study included 60 adult patients aged 18-60 years with American Society of Anaesthesiologists (ASA) physical status I or II who were posted for elective spine surgery. Eligible participants were randomly distributed into two groups of 30 patients each. Patients in Group S were administered intravenous sugammadex 2 mg/kg, whereas patients in Group N received intravenous neostigmine 0.05 mg/kg along with glycopyrrolate 0.01 mg/kg following the return of the second twitch on quantitative Train-Of-Four (TOF) monitoring. The main outcome assessed was the duration required to attain a TOF ratio of ≥0.9. Additional outcomes included extubation time, haemodynamic variables, post-anaesthesia care unit duration, total hospital stay, and treatment-related adverse events. Data were analysed using independent-samples t-test, Chi-square test, and Fisher's-exact test as appropriate, with p<0.05 considered statistically significant. Results: Baseline characteristics were comparable between group S and group N: age 44.8±9.2 versus 46.1±8.7 years; gender 18/12 versus 17/13 (M/F); Body Mass Index (BMI) 24.6±2.8 versus 24.9±2.6 kg/m² ; and ASA I/II 19/11 versus 20/10. Time to TOF ratio ≥0.9 was significantly shorter in group S than group N (2.8±0.9 versus 14.6±3.8 minutes; p<0.001). Time to extubation was also reduced with sugammadex (5.9±1.4 versus 17.8±4.6 minutes; p<0.001). Post-anaesthesia care unit stay was shorter in group S (42±10 versus 58±14 minutes; p<0.001), while hospital stay was comparable (4.1±0.9 versus 4.4±1.0 days; p=0.19). Haemodynamic parameters were similar between groups. Bradycardia was significantly more frequent in group N (1/30 versus 6/30; p=0.04). No serious adverse event was observed. Conclusion: In adult patients undergoing elective spine surgery, sugammadex enabled quicker and more reliable reversal of vecuronium-induced neuromuscular blockade than the conventional neostigmine–glycopyrrolate regimen. It shortened the time to extubation and post-anaesthesia care unit stay without compromising haemodynamic stability. Its main benefit was seen during immediate postoperative recovery.