Background: Reversal of neuromuscular blockade is critical for safe recovery following general anesthesia. Traditional agents like neostigmine are associated with delayed recovery and adverse effects. Sugammadex, a selective relaxant binding agent, offers a newer alternative with rapid and complete reversal of aminosteroid-induced blockade. Objectives: To compare the efficacy, safety, and recovery profile of sugammadex versus neostigmine in reversing rocuronium-induced neuromuscular blockade in adult patients undergoing elective surgeries under general anesthesia. Materials and Methods: This prospective, comparative study was conducted at SMIMS, Tamil Nadu, with 80 adult patients randomized into two groups (n=40 each). Group S received intravenous sugammadex (2 mg/kg), and Group N received neostigmine (50 µg/kg) with glycopyrrolate (10 µg/kg). Neuromuscular monitoring was performed using train-of-four (TOF) stimulation. The primary outcome was time to recovery of TOF ratio ≥ 0.9. Secondary outcomes included extubation time, time to orientation, PACU discharge time, adverse effects, and cost-effectiveness. Results: Sugammadex significantly reduced the time to TOF ≥ 0.9 (2.4 ± 0.8 min vs. 6.8 ± 2.2 min, p < 0.001). Faster extubation and orientation times, and shorter PACU stays were observed in the sugammadex group. Adverse events such as bradycardia and nausea were more common with neostigmine. Despite higher drug cost, sugammadex was associated with better perioperative efficiency and fewer complications. Conclusion: Sugammadex is a safe and more effective alternative to neostigmine for reversal of neuromuscular blockade, providing faster recovery and fewer side effects.

Sugammadex, Neostigmine, Rocuronium, Neuromuscular Blockade, Reversal Agents, Anesthesia Recovery, Train-of-Four