Effect of rocuronium-sugammadex versus cisatracurium on motor evoked potentials (RECAP-MEP)-A randomized controlled trial.

Background: Transcranial motor-evoked potentials (TcMEPs) are essential for monitoring spinal cord integrity during spine surgery, but are highly sensitive to neuromuscular blocking agents. This study compared the effects of rocuronium reversed with sugammadex versus cisatracurium on TcMEP amplitude and recovery characteristics during thoracic and lumbar spine surgery. Methods: A double-blinded, randomized controlled trial was conducted in 60 patients undergoing elective spine surgery. Participants were randomized to receive either rocuronium 0.6 mg/kg with sugammadex reversal (Group R, n = 30) or cisatracurium 0.15 mg/kg (Group C, n = 30). Primary outcomes included MEP amplitude and latency at 5, 10, 20, 30, and 60 min post-obtaining the fourth twitch in the train-of-four (TOF) sequence with a peripheral nerve stimulator. Secondary outcomes measured TOF recovery times and intraoperative adverse events. Data were presented as mean ± standard deviation. The normally distributed continuous variables were compared using Student's t-test, with P < 0.05 considered statistically significant. Results: Group R demonstrated significantly higher MEP amplitudes and shorter MEP latency at all time points from baseline till 30 min as compared to group C (P < 0.05). TOF recovery was significantly faster in group R (P < 0.001) as compared to group C. Group R had a higher incidence of nociception-induced movements (P = 0.076) and excessive field movements (P = 0.118), which was not statistically significant. The total propofol dosage in group R was significantly higher (P = 0.042) compared to group C. No postoperative neurological deficits occurred in either group. Conclusion: At similar TOF ratios, sugammadex-facilitated reversal of rocuronium results in superior quality of MEP parameters, such as higher MEP amplitude and shorter MEP latency, with no significant difference in adverse movements compared to single-dose cisatracurium.