Sugammadex use can decrease the incidence of post-operative urinary retention by avoiding anticholinergics: a retrospective study

Background: Postoperative urinary retention (POUR) is a common complication after total knee arthroplasty (TKA) and associated with the use of anticholinergics. The introduction of sugammadex has decreased perioperative use of anticholinergics. Since anticholinergics may influence the detrusor muscle, the purpose of this study was to compare incidence of POUR between sugammadex and anticholinergic use for reversal of muscle relaxant. Methods: This study was a retrospective cohort study in a university-affiliated hospital. A total of 571 patients who underwent TKA between 2015 and 2016 with an American Society of Anesthesiologists class ≤ 3 were included in this study. Patients who received sugammadex (group S, n = 208) were compared to those who received glycopyrrolate with pyridostigmine (group C, n = 363) for reversal of neuromuscular blockade. The primary outcome was the incidence of POUR. Secondary outcomes were hospital length of stay (HOS) and daily residual urine drained from intermittent catheterization. Demographic, intraoperative, and laboratory data were collected. Results: The incidence of POUR was significantly lower in group S compared to group C (36.1 vs. 48.8%, P = 0.003). On post-operative day (POD) 0, there was no significant difference in the residual urine volume between the two groups. However, from POD 1 to POD 4, the residual urine volume was significantly lower in group S compared to group C. There was no significant difference in HOS between the two groups. Conclusions: The use of sugammadex was associated with a lower incidence of POUR by avoiding glycopyrrolate in patients underwent TKA. Keywords: Arthroplasty; replacement; knee; Cholinergic antagonists; Urinary retention