The Role of Sugammadex in Facilitating Enhanced Recovery After Surgery (ERAS) Protocols: A Retrospective Review of Reversal Practices and Postoperative Pulmonary Complications

Background: The reliable reversal of neuromuscular blockade (NMB) is critical in Enhanced Recovery After Surgery (ERAS) pathways. Sugammadex offers a novel mechanism for NMB reversal, potentially offering advantages over traditional acetylcholinesterase inhibitors.
Methods: Retrospective observational study of 385 adult patients enrolled in ERAS protocols at King Hussein Medical Center (January 2023–December 2025). Patients received sugammadex (n=198) or neostigmine/glycopyrrolate (n=187). Primary outcomes: time to extubation and PACU discharge readiness. Secondary outcomes: residual neuromuscular blockade (TOF <0.9), postoperative pulmonary complications (PPCs), and hospital length of stay.
Results: Sugammadex was associated with shorter time to extubation (median 8.5 vs. 15.2 minutes, p<0.001) and reduced PACU discharge readiness time (median 45 vs. 68 minutes, p<0.001). PPC incidence was significantly lower in the sugammadex group (8.1% vs. 18.7%, p=0.002). Residual blockade was documented in 3.5% of sugammadex patients vs. 15.0% of neostigmine patients (p<0.001). Multivariable analysis identified sugammadex use as independently associated with reduced PPC risk (OR=0.38, 95% CI: 0.21–0.69, p=0.001).
Conclusion: Sugammadex use within ERAS protocols is associated with faster recovery milestones, reduced residual neuromuscular blockade, and lower rates of postoperative pulmonary complications compared to neostigmine-based reversal.