Sugammadex versus anticholinesterase reversal of neuromuscular blockade in adult surgical patients: a systematic review and meta-analysis.
5 affiliations
- 1Department of Surgical Subspecialities, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia.
- 2King Salman Armed Forces Hospital, Tabuk, Saudi Arabia.
- 3Department of Anesthesia, King Abdulaziz Medical City, Ministry of the National Guard Health Affairs, Riyadh, Saudi Arabia.
- 4SEHA Virtual Hospital, Makkah, Saudi Arabia.
- 5King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Abstract
Background
Residual neuromuscular blockade after general anaesthesia is a cause of postoperative pulmonary complications and delayed recovery. Sugammadex, a relaxant-binding agent, is a fast-acting antidote for aminosteroid neuromuscular block which works through encapsulation, in contrast to acetylcholinesterase inhibitors like neostigmine. This study evaluated the effectiveness, postoperative recovery and complications associated with sugammadex versus conventional anticholinesterase reversal drugs in adult surgical patients.Method
This systematic review and meta-analysis was done based on the PRISMA 2020 statement. Databases like PubMed/MEDLINE and Scopus were used to search the literature from January 2000 to December 2025. Studies comparing the use of sugammadex to anticholinesterase agents in adult surgical patients were included, both randomised and non-randomised. Two independent reviewers screened, extracted data and assessed the risk of bias. Analyses were carried out in RevMan 5.3 software using random-effect models; the odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes were used with 95% confidence intervals (CI). Evidence certainty was assessed using the GRADE approach.Results
Total of ten studies (n = 4,082) were included; 5 randomised control trials and 5 observational studies. There was no statistically significant reduction in postoperative pulmonary complications with sugammadex compared to anticholinesterase (3 studies, n = 688; OR 0.75, 95% CI 0.47-1.20; p = 0.23; I² = 77%). There was faster recovery of neuromuscular function with sugammadex, however, there was very high heterogeneity among the studies and the pooled estimate cannot be interpreted as one single effect size (2 studies; I² = 100%). Recovery time after surgery was reduced (3 studies, n = 260; MD -6.66 min, 95% CI -6.96 to -6.35; p < 0.00001; I² = 87%) and time to first bowel movement was also earlier (2 studies, n = 559; MD -13.81 h, 95% CI -19.16 to -8.45; p < 0.00001; I² = 0%). There were no statistically significant differences for PACU stay (MD 1.55 min, 95% CI -1.60 to 4.69), readmission rate (OR 0.93, 95% CI 0.62-1.39) and postoperative nausea/vomiting (OR 0.86, 95% CI 0.48-1.56).Conclusion
Faster neuromuscular recovery, shorter recovery time after surgery and early return of bowel function was associated with the use of sugammadex rather than the anticholinesterase agents. There were no differences found for postoperative pulmonary complications, PACU stay, readmission rate or nausea and vomiting. These results are based on small number of clinically heterogeneous studies, in which only 2-4 studies were used in pooling and thus should be considered as preliminary results.Systematic review registered
CRD420261364292.
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BibTeX
@article{aldobekhi2026sugammadex,
title = {{Sugammadex versus anticholinesterase reversal of neuromuscular blockade in adult surgical patients: a systematic review and meta-analysis.}},
author = {Faris Suleiman Saleh Aldobekhi and Mohammed Fahad Aldhahi and Fahad Awadh Almalki and Mohammed Aljahdali and Hassan Alshamrani and Somaia Sameer Akbar and Sultan Awwadh Almalki},
journal = {Frontiers in medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1891778},
url = {https://europepmc.org/article/MED/42909100},
note = {CC BY},
}
RIS
TY - JOUR
TI - Sugammadex versus anticholinesterase reversal of neuromuscular blockade in adult surgical patients: a systematic review and meta-analysis.
AU - Faris Suleiman Saleh Aldobekhi
AU - Mohammed Fahad Aldhahi
AU - Fahad Awadh Almalki
AU - Mohammed Aljahdali
AU - Hassan Alshamrani
AU - Somaia Sameer Akbar
AU - Sultan Awwadh Almalki
PY - 2026
DA - 2026/10/07
JO - Frontiers in medicine
DO - 10.3389/fmed.2026.1891778
UR - https://europepmc.org/article/MED/42909100
AB - Background Residual neuromuscular blockade after general anaesthesia is a cause of postoperative pulmonary complications and delayed recovery. Sugammadex, a relaxant-binding agent, is a fast-acting antidote for aminosteroid neuromuscular block which works through encapsulation, in contrast to acetylcholinesterase inhibitors like neostigmine. This study evaluated the effectiveness, postoperative recovery and complications associated with sugammadex versus conventional anticholinesterase reversal drugs in adult surgical patients.Method This systematic review and meta-analysis was done based on the PRISMA 2020 statement. Databases like PubMed/MEDLINE and Scopus were used to search the literature from January 2000 to December 2025. Studies comparing the use of sugammadex to anticholinesterase agents in adult surgical patients were included, both randomised and non-randomised. Two independent reviewers screened, extracted data and assessed the risk of bias. Analyses were carried out in RevMan 5.3 software using random-effect models; the odds ratio (OR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes were used with 95% confidence intervals (CI). Evidence certainty was assessed using the GRADE approach.Results Total of ten studies (n = 4,082) were included; 5 randomised control trials and 5 observational studies. There was no statistically significant reduction in postoperative pulmonary complications with sugammadex compared to anticholinesterase (3 studies, n = 688; OR 0.75, 95% CI 0.47-1.20; p = 0.23; I² = 77%). There was faster recovery of neuromuscular function with sugammadex, however, there was very high heterogeneity among the studies and the pooled estimate cannot be interpreted as one single effect size (2 studies; I² = 100%). Recovery time after surgery was reduced (3 studies, n = 260; MD -6.66 min, 95% CI -6.96 to -6.35; p < 0.00001; I² = 87%) and time to first bowel movement was also earlier (2 studies, n = 559; MD -13.81 h, 95% CI -19.16 to -8.45; p < 0.00001; I² = 0%). There were no statistically significant differences for PACU stay (MD 1.55 min, 95% CI -1.60 to 4.69), readmission rate (OR 0.93, 95% CI 0.62-1.39) and postoperative nausea/vomiting (OR 0.86, 95% CI 0.48-1.56).Conclusion Faster neuromuscular recovery, shorter recovery time after surgery and early return of bowel function was associated with the use of sugammadex rather than the anticholinesterase agents. There were no differences found for postoperative pulmonary complications, PACU stay, readmission rate or nausea and vomiting. These results are based on small number of clinically heterogeneous studies, in which only 2-4 studies were used in pooling and thus should be considered as preliminary results.Systematic review registered CRD420261364292.
SN - 2296-858X
ER -