The Use of Sugammadex for Neuromuscular Blockade Reversal after Inguinal Hernia Repair: A Systematic Review and...

Postoperative urinary retention (POUR) is a common complication following inguinal hernia repair (IHR), and it can be influenced by the type of neuromuscular blockade reversal medication used, especially acetylcholinesterase inhibitors. Among the available options for neuromuscular blockade reversal, Sugammadex has gained significant popularity due to its effectiveness, speed, and safety profile. Additionally, some studies suggest that it prevents POUR compared to acetylcholinesterase inhibitors. We aimed to perform a systematic review and meta-analysis to assess the POUR rates with the use of Sugammadex after IHR.

PubMed, EMBASE, Cochrane, LILACS, and Web of Science databases were systematically searched without date or language restrictions from inception to October 2024. The databases were searched for studies comparing Sugammadex with other medications for neuromuscular blockade reversal after IHR. The primary outcome was POUR.

From 212 records, 3 retrospective cohort studies and 1 clinical trial were included in our pooled analysis, totaling 1390 patients. 573 (41.2%) patients were in the Sugammadex group, compared to 817 (58.8%) patients in the non-Sugammadex group. 135 (9.7%) patients underwent open IHR, compared to 468 (33.6%) patients who underwent minimally invasive repairs. Our meta-analysis revealed that the use of Sugammadex was associated with a significantly lower risk of POUR compared to other medications (RR 0.11; 95% CI 0.05, 0.28; P < .001), with a relative risk reduction of 89%.

Sugammadex is associated with a significantly lower risk of POUR following IHR when compared to other medications for neuromuscular blockade reversal following IHR. Despite its higher cost and decreased availability in some centers, the use of Sugammadex should be strongly considered as the preferred option to prevent POUR and minimize the need for hospital readmissions.