Muscle Weakness Clinical Trial
Official title:
Deep Versus Moderate Neuromuscular Blockade for Optimising Surgical Conditions Include Patient Benefits During Spinal Surgery: A Randomized Controlled Double Blinded Clinical Study
In the present study, the investigators compare intermediate and deep NMB i.e. the two
extreme regimes of muscle paralysis (neuromuscular block; NMB), (I) patients receiving
intermediate muscle paralysis (''control, conventional NMB'') versus (II) patients with a
deep neuromuscular blockade with rocuronium (''Deep NMB''), will be compared during a
surgical procedure which is considered to be very sensitive for inadequate muscle relaxation,
elective minimally invasive spinal surgery.
The primary objective of this trial is to compare the operation time reduction with the help
of the decreased stiffness of targeted back muscle surrounding the surgical field.
The changed back muscle stiffness also measured as secondary objective goal by a mechanical
tension weighing scale and also taking ultrasonography using shear wave elastography (SWE).
Other observational objectives are divided into the following categories of stakeholders:
patients, surgeons and anesthesiologists', done by collecting the variety of clinical
parameters. The following will be collected and compared.
1. For patients Intraoperative radiation amount, post-anesthetic care unit(PACU) stay,
transfer rate to SICU for post-op. care, post-operative respiratory complication rate,
and total hospital costs.
2. For surgeons Post-operative complications in regard to operation field, and evaluate
surgical conditions using a Visual Analogue Scale(VAS score) in surgeon's side.
3. For anesthesiologists Intraoperative ventilation parameters of patients, and evaluate
surgical conditions using a Visual Analogue Scale(VAS score) in anesthesiologist's side.
All patients will be randomly assigned to two groups after IRB (institutional review board)
approval, receiving either deep neuromuscular blockade (''Deep NMB'') or intermediate
neuromuscular block (''Control NMB''). Enrolled patients will be given a number in sequence
of their enrollment and received a treatment code using a randomization schedule.
The team taking care of patient perioperatively will be blinded regarding the study; this
included the surgeons (This study use two different responsible surgeon attendings) and their
team, the anesthesia care team in the operating room, in the PACU and the pain physician
responsible for postoperative pain management (same as the protocols of the departmental and
hospital clinical process).
An additional unblinded anesthesiologist involved in the study management will present from
patients' arrival in the operation room to the patients' discharge from the PACU. The
unblinded study anesthesiologist takes care of the patients' anesthesia induction,
calibration and documentation of the neuromuscular monitoring and the management of the
neuromuscular blockade.
Primary endpoint:
To compare the measurements of the operation time reduction, the operation time should be
recorded by institutional electronic medical chart from the incision to the final suture
closure of surgical wound. A difference of 10% change of operation time between two groups is
considered of clinically meaningful difference.
Secondary endpoints:
By using Mechanical Tension Weighing Scale (MTWS) of mechanical dynamometer and also Shear
Wave Ultrasound Elastography(SWE), values are taken as followings.
1. Shear Wave Ultrasound Elastography(SWE):
SWE score value will be collected 3 times as followings. First, After enrolled, the
obtained informed consent for this clinical study and screening, SWE score measure will
be taken prior to surgery as a basal value from the patient.
Second, After Induction and patient positioning, measure the targeted back muscle
stiffness by using ultrasonography of SWE.
Third, SWE score measure finally after the stich out before the discharge.
2. Mechanical Tension Weighing Scale(MTWS) of mechanical dynamometer:
After surgical incision, measure the targeted back muscle stiffness by using MTWS. It will be
compared between the study groups.
Other check points:
To compare the safety and benefits of deep neuromuscular block over intermediate conventional
NMB with corresponding sugammadex reversal.
(Other check points might be changed before the clinical trial initiation circumstantially)
The other check point variables will be collected for investigating to compare the safety and
benefits which are divided into patients, surgeons and anesthesiologists' ones by collecting
the variety of clinical parameters.
1. For patients intraoperative radiation amount, operation duration, anesthesia duration,
post-anesthetic care unit(PACU) stay, transfer rate to SICU for post-op. care,
post-operative respiratory complication rate, post-op pain score include patient
controlled analgesia(PCA), post-op nausea and vomiting(PONV), and total hospital costs.
2. For surgeons unintended movements during surgery, compromised operating field by tense
surrounding muscles, post-operative complications in regard to operation field, and
evaluate surgical conditions using a Visual Analogue Scale(VAS score) which will be
correlated with muscle stiffness measure by weighing scale and SWE.
3. For anesthesiologists Anesthetic time, intraoperative ventilation parameters of
patients, intraoperative vital sign monitor values, and evaluate surgical conditions
using a Visual Analogue Scale(VAS score) which will be correlated with muscle stiffness
measure by weighing scale and SWE.
All clinical parameters will be collected within 48 hours after surgery except the total
hospital costs of the patients.
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