Reversal Agents for Postoperative Urinary Retention

This trial aims to determine whether sugammadex or neostigmine, both muscle relaxant reversal agents, more effectively reverses muscle relaxation effects used during surgery. The focus is on adults undergoing surgery lasting at least two hours and requiring muscle relaxation drugs like rocuronium or vecuronium. Participants should be adults having non-heart-related surgery and planning to use one of these reversal agents. This study could enhance recovery after surgery by reducing urinary problems linked to anesthesia. As a Phase 4 trial, this research involves treatments already FDA-approved and proven effective, seeking to understand how they benefit more patients.

The trial does not specify if you need to stop all current medications, but you cannot participate if you are currently using anticholinergic medications like antihistamines, phenothiazines, antidepressants, or antipsychotics.

Research shows that both neostigmine and sugammadex safely aid muscle recovery after surgery, but they have different effects. Studies have found that neostigmine might make urination more difficult post-surgery. While effective, this issue may occur more frequently than with other treatments. Sugammadex, on the other hand, usually reduces the risk of urination difficulties. Research suggests it significantly lowers this risk compared to neostigmine. Both treatments are generally well-tolerated, but these findings about urination could be important for those considering participation in a clinical trial.¹²³⁴⁵

Researchers are excited about these treatments for postoperative urinary retention because they offer potentially faster and more effective reversal of neuromuscular block. Sugammadex is unique because it directly encapsulates the muscle relaxant molecules, quickly reversing their effects, which is different from the traditional cholinesterase inhibitors like neostigmine that work by increasing acetylcholine levels to counteract the block. Additionally, when neostigmine is paired with glycopyrrolate, it helps to reduce unwanted side effects like bradycardia, making it a more balanced option. These approaches promise quicker recovery and fewer complications for patients after surgery.

This trial will compare the effectiveness of sugammadex and neostigmine in reversing neuromuscular block after surgery. Research has shown that both drugs aid recovery from muscle relaxants. Sugammadex, which participants in this trial may receive, significantly reduces the risk of postoperative urinary retention (POUR). Studies also indicate that sugammadex does not affect other recovery aspects, such as the need to return to the hospital. Neostigmine, another treatment option in this trial, has shown mixed results. It can sometimes increase the risk of POUR, although some studies suggest it might help reduce leftover urine in the bladder. Overall, sugammadex appears more effective at managing urinary issues after surgery.¹²³⁵⁶