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

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.

Keywords: laparoscopic cholecystectomy; neostigmine; patient-reported outcome; quality of recovery; sugammadex.

Figure A1

The Korean version of Quality of Recovery-15 questionnaire. The shortened version of quality of recovery-15 questionnaire, date, operation date, number of patient, Read the following questions and mark the applicable scores. I. How have you been feeling in the last 24 hours? 0 = none of the time, 10 = all of the time. II. Have you had any of the following symptoms in the last 24 hours? 10 = none of the time, 0 = all of the time.

Figure A1

The Korean version of Quality of Recovery-15 questionnaire. The shortened version of quality of recovery-15 questionnaire, date, operation date, number of patient, Read the following questions and mark the applicable scores. I. How have you been feeling in the last 24 hours? 0 = none of the time, 10 = all of the time. II. Have you had any of the following symptoms in the last 24 hours? 10 = none of the time, 0 = all of the time.

Figure 1

Consort flow diagram.

Figure 2

Quality of Recovery-15 at pre-operative and post-operative 1 and 2 days. (a) Global scores; (b) Physical comfort; (c) Physical independence; (d) Pain; (e) Physical support; (f) Emotional state. Data are mean with error bars showing SD. Neostigmine (dark gray rombus); Sugammadex (light gray square). There were no significant differences in QoR-15 global or sub-scores between neostigmine and sugammadex groups.