This study aimed to evaluate whether sugammadex reduces the incidence of postoperative nausea and vomiting (PONV) compared to neostigmine in patients undergoing laparoscopic abdominal surgery under a standardized anesthetic and antiemetic regimen.

In this randomized controlled trial, 114 adult patients scheduled for elective laparoscopic abdominal surgery were randomly assigned to receive either sugammadex or neostigmine for neuromuscular blockade reversal. All patients received standardized multimodal PONV prophylaxis, including dexamethasone, palonosetron, and acetaminophen. In addition, fentanyl-based intravenous patient-controlled analgesia was administered for postoperative pain control. The primary outcome was the incidence of PONV within 48 h after surgery. Secondary outcomes included PONV severity, analgesic use, and length of hospital stay.

A total of 109 patients were included in the final analysis. The overall incidence of PONV within 48 h did not differ significantly between the sugammadex and neostigmine groups (23.6% vs. 35.2%, P = 0.186). On postoperative day 1, a significantly lower incidence of PONV was observed in the sugammadex group compared to the neostigmine group (5.5% vs. 24.1%, P = 0.006). Other variables showed no significant differences.

Sugammadex did not significantly reduce the overall incidence of PONV within 48 h after surgery. However, a significant reduction in PONV was observed on postoperative day 1, suggesting a potential benefit in early postoperative period. In clinical settings where multimodal prophylaxis is routinely applied, the additional antiemetic benefit of sugammadex may be limited. Further studies are warranted to identify patient subgroups that may derive greater benefit from sugammadex in terms of PONV reduction.

Registry: Clinical Research Information Service. Number: KCT0008895. Date: 27 October, 2023.