Objective To explore the effects of different doses of calcium gluconate injection combined with neostigmine on the recovery of neuromuscular blockade（NMB）in elderly patients after laparoscopic surgery. Methods 180 elderly patients who underwent elective laparoscopic surgery at the Affiliated Hospital of Xuzhou Medical University from April 2022 to August 2022 were selected and divided into four groups randomly. Intraoperatively, the degree of NMB was monitored by four train-of-four stimulation (TOF) patterns. At the end of the operation, when the TOF count（TOFc）≥3, 40 μg/kg neostigmine combined with 20 μg/kg atropine was injected intravenously. Meanwhile，the group C5、C10、C20 were given calcium gluconate injection 5、10、20 mg/kg combined with both neostigmine 40 μg/kg and atropine 20 μg/kg to antagonize NMB respectively，the group N was given equal volume of saline. The time to TOFr（T4/T1）≥0.90 and the TOFr were assessed at 5, 10，15 and 20 min, and the incidence of PORC. The Ricker Sedation Agitation Scale (SAS) score at the time of extubation, hypoxemia、agitation、nausea and vomiting、dysphonia, the duration of stay in the post-anesthesia care unit（PACU) were evaluated. Changes in heart rate（HR）, mean arterial pressure（MAP）and blood calcium concentration were also recorded.Results The time of TOFr≥0.90 was13.00（10.25,15.00）min in group N, 10.50（9.00,12.00）min in group C5, 9.50（7.00,12.00）min in group C10 and 7.50（6.00，9.00）min in group C20， the difference was statistically significant (P＜0.05). The SAS score of group C20 was better than that of group N (P＜0.05). Compared with group N, the incidence of PORC, hypoxemia and the duration of stay in PACU in calcium gluconate group were reduced(P＜0.05). Postoperative agitation, nausea and vomiting, and dysphonia were not significantly different among the four groups (P＞0.05). Conclusion Calcium gluconate can be safely used for elderly patients, promote the recovery of neuromuscular effectively，reduce the incidence of PORC，moreover，the recovery process was more stable in group C20