- Design
- Prospective randomised paired comparison
- Population
- 44 adults receiving rocuronium and sugammadex under general anaesthesia
- Primary outcome
- Onset time and recovery to TOF ratio 0.9 and 1.0
- Effect
- No overall difference; dominant-hand ADM recovered 93 s earlier to TOF 0.9
A randomised study in Anesthesiology (17 September 2026) recorded electromyographic responses simultaneously from the adductor pollicis and the abductor digiti minimi in 44 patients given rocuronium and reversed with sugammadex, randomising which muscle was monitored on which hand.
Overall, onset time and recovery to a train-of-four ratio of 0.9 and 1.0 did not differ between the muscles. On the right (dominant) hand, though, the abductor digiti minimi recovered earlier, by a mean of 93 seconds to a ratio of 0.9 and 105 seconds to 1.0. On the left hand there was no difference.
Guidelines name the adductor pollicis, but many electromyographic monitors are easier to place over the little finger. This suggests that is acceptable on the non-dominant arm. On the dominant arm, the little finger may tell you the patient has recovered a minute or more before the thumb would.
- Monitor at the adductor pollicis where possible, as guidelines recommend.
- If you use the abductor digiti minimi, prefer the non-dominant hand.
- On the dominant hand, allow extra time after the little finger reaches a train-of-four ratio of 0.9.
- Use quantitative monitoring, not tactile assessment, to confirm recovery before extubation.
Why it matters
A monitoring site chosen for convenience could prompt extubation before the thumb has recovered.
Don't overread it
Forty-four patients and the hand effect was a secondary finding; it needs confirming.
The statistics, in plain English
Ninety-three seconds is about a quarter of the recovery time here. In a small study, a subgroup difference like the hand effect can arise by chance, so treat it as a caution rather than a rule.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for anaesthesiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free