Neuromuscular BlockadeNCT02285829
Determination of TOF Test Threshold for Obtaining Reliable Pedicle Screw Stimulation Test During Lumbar Spine Surgery
An observational study of Neuromuscular Blockade, run by NYU Langone Health at 1 site in United States.
Trial summary
During lumbar spine fusion surgery intraoperative neurophysiological monitoring is in routine use for prevention of possible nerve injuries during placement of screw into pedicle. Pedicle screw stimulation test is performed to assess if screw placement is encroaching on the nerve roots. Read more about this study
- Who is it for?
- Ages 18 to 85 years
- Conditions the study is for
- Neuromuscular Blockade
- What is being tested?
- Rocuronium Bromide, Cisatracurium Besylate
- Type of treatment
- Injection or infusion
- How many people
- 46 participants
- Where
- 1 siteUnited States
- Study dates
- 11 Feb 2015to 8 Jan 2018
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 85 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Study population: Subjects undergoing elective lumbar spine fusion surgery
Who may be able to join
- Subjects undergoing lumbar spine fusion surgery with neurophysiologic intraoperative monitoring when pedicle screw stimulation test is performed.
- Subjects of both gender
- Age 18-85
- With diagnosis of lumbar spinal stenosis.
- All subjects capable of giving informed consent in order to be included for the study.
Who cannot join
- Subjects with medical history of presence of neuromuscular disease
Trial locations and contacts
1 site in 1 country.
United States1 site
NYU Langone Medical Center, Hospital for Joint Diseases
New York, New York, 10003
About this study
During lumbar spine fusion surgery intraoperative neurophysiological monitoring is in routine use for prevention of possible nerve injuries during placement of screw into pedicle. Pedicle screw stimulation test is performed to assess if screw placement is encroaching on the nerve roots. Relative distance between the pedicle screw and the neighbouring root can be estimated by the intensity of the current required to activate the root and appropriate muscle. A properly placed screw can be distinguished from those perforating the pedicle wall by its higher minimum level of electrical current needed to elicit a muscle response. The minimum level is deemed as threshold. This test is based on compound muscle action potential (CMAP) and use of neuromuscular blocking agents (NMBA) should be avoided because of possible cause of false negative results of screw stimulation test. Neuromuscular blocking agents, which are in routine use during anesthesia, will have effect on muscle action potential. When NMBA are used current stimulus will depolarize the same number of axons and the associated muscle response will be present but of lower amplitude because some percentage of motor fibers will be blocked by activity of NMBA. At this point, stronger stimulus is needed to recruit additional axons/muscle fibers , and hence, the measured threshold is elevated.
Train of four (TOF) test is method used to determine level of neuromuscular blockade, by stimulation of peripheral nerve and following induced muscle contractions. Interpretation of muscle contractions may be by subjective (visual) or objective (quantitative) method. Quantitative TOF test may be used prior screw stimulation test by calculating T4/T1 ratio and obtaining quantitative value which shows level of neuromuscular blockade. Residual neuromuscular blockade may be present before screw stimulation test, and effect on accuracy of this test in this situation was not clearly investigated in recent studies.
The purpose of this study would be to determine changes of screw stimulation thresholds under different range of neuromuscular blockade.Therefore, acceptable neuromuscular blockade threshold (determined by TOF test) acceptable for obtaining reliable screw stimulation test should be determined. Screw stimulation test may be performed when neuromuscular blockade is absent and compared to repeated screw stimulation test when neuromuscular blockade is present. Different levels of neuromuscular blockade may provide different results on screw stimulation test, so if difference is statistically significant, induced neuromuscular blockade level may be set as threshold value, acceptable for obtaining reliable testing results.
- Conditions
- Neuromuscular Blockade
- Being tested
- Rocuronium Bromide, Cisatracurium Besylate
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Rocuronium Bromide, Cisatracurium BesylateDrug
Also called Zemurone, Nimbex
Both Rocuronium Bromide and Cisatracurium Besylate are administered intravenously following induction of anesthesia initially by bolus, and subsequently re-bolused or administered in continuous infusion as clinically indicated to maintain muscle relaxation. Initial doses of Rocuronium range from 0.45 to 1.2 mg/kg IV, and doses for continuous infusion range from 0.01-0.012 mg/kg/min IV. Initial doses of Cisatracurium range from 0.15 to 0.2 mg/kg, and doses for continuous infusion range from 0.5 to 3 µg/kg/min. Following recovery and baseline screw stimulation at TOF >0.9, the dosing regimen for this study will rely on restarting a continuous infusion, and adjusting the infusion until the desired TOF ratios are reached. Following screw stimulations and data collection, the infusion will be terminated, and neuromuscular blockade allowed to recover.
| Study group | Role | What they receive |
|---|---|---|
| T4/T1=0.1-0.25 | Continuous infusion will commence at the lower dose indicated (0.01mg/kg/min IV for Rocuronium, 0.5 µg/kg/min for Cisatracurium ), and TOF ratios will be monitored every 20 seconds. T4/T1 ratio of quantitative TOF test will be measured, prior pedicle screw stimulation test. When TOF ratio ranges 0.1-0.25, values of pedicle screw stimulation test will be then measured and recorded in milliamps (mA) after TOF test is performed. Receives: Drug: Rocuronium Bromide, Cisatracurium Besylate | |
| T4/T1=0.25-0.50 | Continuous infusion will commence at the lower dose indicated (0.01mg/kg/min IV for Rocuronium Bromide, 0.5 µg/kg/min for Cisatracurium Besylate ), and TOF ratios will be monitored every 20 seconds. T4/T1 ratio of quantitative TOF test will be measured, prior pedicle screw stimulation test. When TOF ratio ranges 0.25-0.50, values of pedicle screw stimulation test will be then measured and recorded in milliamps (mA) after TOF test is performed. Receives: Drug: Rocuronium Bromide, Cisatracurium Besylate | |
| T4/T1=0.50-0.75 | Continuous infusion will commence at the lower dose indicated (0.01mg/kg/min IV for Rocuronium Bromide, 0.5 µg/kg/min for Cisatracurium Besylate ), and TOF ratios will be monitored every 20 seconds. T4/T1 ratio of quantitative TOF test will be measured, prior pedicle screw stimulation test. When TOF ratio ranges 0.50-0.75, values of pedicle screw stimulation test will be then measured and recorded in milliamps (mA) after TOF test is performed. Receives: Drug: Rocuronium Bromide, Cisatracurium Besylate | |
| T4/T1=0.75-0.90 | Continuous infusion will commence at the lower dose indicated (0.01mg/kg/min IV for Rocuronium Bromide, 0.5 µg/kg/min for Cisatracurium Besylate ), and TOF ratios will be monitored every 20 seconds. T4/T1 ratio of quantitative TOF test will be measured, prior pedicle screw stimulation test. When TOF ratio ranges 0.75-0.90, values of pedicle screw stimulation test will be then measured and recorded in milliamps (mA) after TOF test is performed. Receives: Drug: Rocuronium Bromide, Cisatracurium Besylate |
What is being measured
The primary outcome is the main question the study is designed to answer.
Train of four (TOF) test
T4/T1 ratio will be determined and measured prior pedicle screw stimulation test, during lumbar spine surgery. Data will be obtained and followed from participants during one day, while surgery is performed.
Measured: TOF test measure will be performed during the day of surgery prior pedicle screw stimulation test
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Nov 2014 (estimated)
- Study start11 Feb 2015
- Primary completion8 Jan 2018
- Study completion8 Jan 2018
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Neuromuscular BlockadeStudies of the same condition, open and under way.
- More trials run by NYU Langone HealthThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 46 participants (actual)
Sponsor and investigators
- Lead sponsor
- NYU Langone Health
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor
- Investigators
- Aleksandar Beric, MD, Principal investigator, Neurologist
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02285829
- Sponsor's protocol ID
- 14-01568
- Status last verified
- Jan 2018
- First submitted
- 27 Oct 2014
- Last updated
- 18 Jan 2018
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 18 Jan 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Determination of TOF Test Threshold for Obtaining Reliable Pedicle Screw Stimulation Test During Lumbar Spine Surgery
- ClinicalTrials.gov ID
- NCT02285829
- Acronym / sponsor ID
- 14-01568
- Conditions
- Neuromuscular Blockade
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 46 participants (actual)
- Lead sponsor
- NYU Langone HealthUniversity, hospital or other
- Study start
- 11 Feb 2015 (actual)
- Primary completion
- 8 Jan 2018 (actual)
- Study completion
- 8 Jan 2018 (actual)
- First posted
- 7 Nov 2014 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
During lumbar spine fusion surgery intraoperative neurophysiological monitoring is in routine use for prevention of possible nerve injuries during placement of screw into pedicle. Pedicle screw stimulation test is performed to assess if screw placement is encroaching on the nerve roots. Relative distance between the pedicle screw and the neighbouring root can be estimated by the intensity of the current required to activate the root and appropriate muscle. A properly placed screw can be distinguished from those perforating the pedicle wall by its higher minimum level of electrical current needed to elicit a muscle response. The minimum level is deemed as threshold. This test is based on compound muscle action potential (CMAP) and use of neuromuscular blocking agents (NMBA) should be avoided because of possible cause of false negative results of screw stimulation test. Neuromuscular blocking agents, which are in routine use during anesthesia, will have effect on muscle action potential. When NMBA are used current stimulus will depolarize the same number of axons and the associated muscle response will be present but of lower amplitude because some percentage of motor fibers will be blocked by activity of NMBA. At this point, stronger stimulus is needed to recruit additional axons/muscle fibers , and hence, the measured threshold is elevated.
Train of four (TOF) test is method used to determine level of neuromuscular blockade, by stimulation of peripheral nerve and following induced muscle contractions. Interpretation of muscle contractions may be by subjective (visual) or objective (quantitative) method. Quantitative TOF test may be used prior screw stimulation test by calculating T4/T1 ratio and obtaining quantitative value which shows level of neuromuscular blockade. Residual neuromuscular blockade may be present before screw stimulation test, and effect on accuracy of this test in this situation was not clearly investigated in recent studies.
The purpose of this study would be to determine changes of screw stimulation thresholds under different range of neuromuscular blockade.Therefore, acceptable neuromuscular blockade threshold (determined by TOF test) acceptable for obtaining reliable screw stimulation test should be determined. Screw stimulation test may be performed when neuromuscular blockade is absent and compared to repeated screw stimulation test when neuromuscular blockade is present. Different levels of neuromuscular blockade may provide different results on screw stimulation test, so if difference is statistically significant, induced neuromuscular blockade level may be set as threshold value, acceptable for obtaining reliable testing results.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 4
| Arm | Type | Receives |
|---|---|---|
| T4/T1=0.1-0.25 | – | Drug: Rocuronium Bromide, Cisatracurium BesylateContinuous infusion will commence at the lower dose indicated (0.01mg/kg/min IV for Rocuronium, 0.5 µg/kg/min for Cisatracurium ), and TOF ratios will be monitored every 20 seconds. T4/T1 ratio of quantitative TOF test will be measured, prior pedicle screw stimulation test. When TOF ratio ranges 0.1-0.25, values of pedicle screw stimulation test will be then measured and recorded in milliamps (mA) after TOF test is performed. |
| T4/T1=0.25-0.50 | – | Drug: Rocuronium Bromide, Cisatracurium BesylateContinuous infusion will commence at the lower dose indicated (0.01mg/kg/min IV for Rocuronium Bromide, 0.5 µg/kg/min for Cisatracurium Besylate ), and TOF ratios will be monitored every 20 seconds. T4/T1 ratio of quantitative TOF test will be measured, prior pedicle screw stimulation test. When TOF ratio ranges 0.25-0.50, values of pedicle screw stimulation test will be then measured and recorded in milliamps (mA) after TOF test is performed. |
| T4/T1=0.50-0.75 | – | Drug: Rocuronium Bromide, Cisatracurium BesylateContinuous infusion will commence at the lower dose indicated (0.01mg/kg/min IV for Rocuronium Bromide, 0.5 µg/kg/min for Cisatracurium Besylate ), and TOF ratios will be monitored every 20 seconds. T4/T1 ratio of quantitative TOF test will be measured, prior pedicle screw stimulation test. When TOF ratio ranges 0.50-0.75, values of pedicle screw stimulation test will be then measured and recorded in milliamps (mA) after TOF test is performed. |
| T4/T1=0.75-0.90 | – | Drug: Rocuronium Bromide, Cisatracurium BesylateContinuous infusion will commence at the lower dose indicated (0.01mg/kg/min IV for Rocuronium Bromide, 0.5 µg/kg/min for Cisatracurium Besylate ), and TOF ratios will be monitored every 20 seconds. T4/T1 ratio of quantitative TOF test will be measured, prior pedicle screw stimulation test. When TOF ratio ranges 0.75-0.90, values of pedicle screw stimulation test will be then measured and recorded in milliamps (mA) after TOF test is performed. |
Who may qualify
- Ages
- 18 to 85 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
- Study population
- Subjects undergoing elective lumbar spine fusion surgery
Key inclusion criteria (5 listed)
- Subjects undergoing lumbar spine fusion surgery with neurophysiologic intraoperative monitoring when pedicle screw stimulation test is performed.
- Subjects of both gender
- Age 18-85
- With diagnosis of lumbar spinal stenosis.
- All subjects capable of giving informed consent in order to be included for the study.
Key exclusion criteria (1 listed)
- Subjects with medical history of presence of neuromuscular disease
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Rocuronium Bromide, Cisatracurium BesylateAlso: Zemurone, NimbexBoth Rocuronium Bromide and Cisatracurium Besylate are administered intravenously following induction of anesthesia initially by bolus, and subsequently re-bolused or administered in continuous infusion as clinically indicated to maintain muscle relaxation. Initial doses of Rocuronium range from 0.45 to 1.2 mg/kg IV, and doses for continuous infusion range from 0.01-0.012 mg/kg/min IV. Initial doses of Cisatracurium range from 0.15 to 0.2 mg/kg, and doses for continuous infusion range from 0.5 to 3 µg/kg/min. Following recovery and baseline screw stimulation at TOF >0.9, the dosing regimen for this study will rely on restarting a continuous infusion, and adjusting the infusion until the desired TOF ratios are reached. Following screw stimulations and data collection, the infusion will be terminated, and neuromuscular blockade allowed to recover. | Drug | T4/T1=0.1-0.25, T4/T1=0.25-0.50, T4/T1=0.50-0.75, T4/T1=0.75-0.90 |
Primary outcome
Train of four (TOF) test
Time frame: TOF test measure will be performed during the day of surgery prior pedicle screw stimulation test
T4/T1 ratio will be determined and measured prior pedicle screw stimulation test, during lumbar spine surgery. Data will be obtained and followed from participants during one day, while surgery is performed.
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Jan 2018.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Aleksandar Beric, MD principal investigator
Neurologist
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Neuromuscular Blockade, run by NYU Langone Health at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 18 Jan 2018. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Train of four (TOF) test (time frame: TOF test measure will be performed during the day of surgery prior pedicle screw stimulation test). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Jan 2018.