Reversal of neuromuscular blockade (NMB) is essential for optimal recovery following general anaesthesia. Neostigmine has long served as the conventional agent for this purpose; however, sugammadex a novel cyclodextrin compound specifically engineered to counteract rocuronium-induced NMB has demonstrated promising advantages in terms of speed and reliability. Although both agents facilitate reversal of rocuronium, their comparative efficacy and safety profiles remain subjects of ongoing clinical scrutiny, particularly when assessed using train-of-four (TOF) neuromuscular monitoring.

This  randomized controlled trial is designed to evaluate the efficacy of sugammadex versus neostigmine for reversing  rocuronium-induced NMB in adult patients undergoing elective surgical procedures under general anaesthesia. TOF monitoring will be employed to ensure objective and quantifiable assessment of efficacy of neuromuscular recovery as determined by the time to achieve the primary outcome.

A total of 100 adult patients who meet eligibility criteria and provide informed consent will be enrolled. The primary outcome is the time required to achieve a TOF ratio (TOFR) of  gretaer than  0.9 after administration of reversal agent. Secondary outcomes include the incidence of adverse respiratory events in the post-anaesthesia care unit (PACU) till 60 minutes after extubation, as well as perioperative changes in hemodynamic parameters, namely, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP).

While international literature consistently supports the superior efficacy of sugammadex over neostigmine in reversing rocuronium-induced NMB,  to the best of our knowledge, there is no study in the Indian population. To address this gap, our study seeks to generate contextually relevant evidence.