Quality of Recovery after Laparoscopic Cholecystectomy Following Neuromuscular Blockade Reversal with Neostigmine or Sugammadex: A Prospective, Randomized, Controlled Trial.

Jiwon Han,Bo Young Kim,Bon-Wook Koo,Donghyun Kim,Yong-Tae Jeon,Insung Hwang,Ah-Young Oh

doi:10.3390/jcm10050938

Jiwon Han, Bo Young Kim + Show 5 more

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https://doi.org/10.3390/jcm10050938

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Abstract

The risk of neuromuscular blockade is certainly minimized by sugammadex in combination with monitoring. However, the effect of sugammadex-aided recovery on patients’ satisfaction is unclear. This study compared the Quality of Recovery (QoR)-15 score, which is a patient-reported outcome, in patients undergoing laparoscopic cholecystectomy. Eighty patients were randomly assigned to the neostigmine or sugammadex groups. At the end of surgery, neostigmine or sugammadex was administered, and tracheal extubation was performed after confirmation of a train of four ratio ≥ 0.9. The QoR-15 questionnaire was administered at 1 day before surgery and on post-operative days (POD) 1 and 2. The primary outcome was the QoR-15 score on POD 1. The secondary outcomes were the QoR-15 score on POD 2, modified Aldrete score, length of post-anesthetic care unit stay, post-operative pain, administration of anti-emetics, urinary retention, and length of hospital stay. No significant differences were found in QoR-15 scores on POD 1 (94.4 vs. 95.5, p = 0.87) or 2 (116.3 vs. 122, p = 0.33). Secondary outcomes were also comparable, with the exception of urinary retention (15.8% neostigmine vs. 2.6% sugammadex, p = 0.04). This study demonstrated that the quality of recovery was comparable between the neostigmine and sugammadex groups when reversal and tracheal extubation were performed in accordance with the current guidelines.

Highlights

Recovery from surgery and anesthesia is a complex process that involves various physical and psychological changes
Another study showed that the use of sugammadex reduced 30-day unplanned readmission, length of hospital stay, and related hospital charges, compared with neostigmine [9]. Despite these studies of sugammadex usage, only a few studies have focused on patient-reported outcomes. In this prospective, randomized, controlled study, we hypothesized that sugammadex would be superior to neostigmine in patient’s recovery, so we evaluated postoperative patient satisfaction following the reversal of neuromuscular blockade (NMB)
Two in the neostigmine group and one in the sugammadex group did not respond on POD1, while two in the sugammadex group did not respond on POD2 (Figure 1)

Summary

Introduction

Recovery from surgery and anesthesia is a complex process that involves various physical and psychological changes. In addition to objective outcomes (e.g., laboratory values and rates of complications, morbidity, and mortality), each patient’s subjective experience and quality of life (e.g., pain, powerlessness, anxiety, and depression) have become important concerns. A validated, reliable tool for evaluation of patient-reported outcomes is the Quality of Recovery (QoR) questionnaire [1,2]. Laparoscopic cholecystectomy is the gold standard treatment for gallbladder disease and is one of the most commonly performed abdominal surgeries. It is a minimally invasive procedure, patients subsequently experience abdominal pain, shoulder tip pain derived from peritoneal stretching, and diaphragmatic irritation caused by the pneumoperitoneum [3,4]. The incidence of post-operative nausea and vomiting is higher than the incidence encountered in other surgeries [5]

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