Comparing Train-of-Four Recovery in the Adductor Pollicis Versus the Adductor Digiti Minimi in Elective Surgery Patients

NCT ID: NCT06467448

Last Updated: 2026-01-13

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 57 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2024-03-18
• Study Completion Date: 2025-06-01

Brief Summary

The train-of-four (TOF) ratio is a quantitative measure used in anesthesia to assess the degree of neuromuscular blockade induced by neuromuscular blocking agents during surgical procedures. Current American Society of Anesthesiologists guidelines recommend monitoring the TOF ratio to guide the administration and reversal of NMBAs, with a target ratio of 0.9 or higher at adductor pollicis muscle indicating adequate reversal and restoration of neuromuscular function.

This proposed study aims to observe and compare the TOF ratio between two different muscles of the hand: adductor pollicis and adductor digiti minim using anesthesia monitors on both of their arms during recovery of neuromuscular function. Surgery and anesthesia will occur per standard of care.

Detailed Description

The study population will enroll adult patients (>18) who will receive non-depolarizing neuromuscular blocking drugs as part of a routine general anesthetic and who will have monitoring of their recovery from neuromuscular block performed using the Tetragraph (Senzime Sweden). Patients with upper limb weakness, neurological deficits, and inability to use the other arm to record the second EMG recording will be excluded.

Procedures (methods):

Adult patients undergoing general anesthesia with the use of muscle relaxants will have anesthesia monitors on both of their arms. On one arm, the study sticky pad will be placed on the forearm and over the base of the little finger. On the other arm, the standard monitor is placed on the forearm and over the base of the thumb.

To identify pre-operative patients, an EPIC report will be utilized to screen for eligible participants. Patients will be contacted via phone by a research team member the day before their procedure and enrolled. Informed consent will be formally obtained on the day of the procedure.

Conditions

Anesthesia; Neuromuscular Blockade

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Adductor Pollicis EMG

The Train of Four Ratio will be recorded at 90% as a time and as a reference point

EMG Assessement of Recovery of Neuromuscular Function

Intervention Type: DEVICE

EMG Train of Four Assessment of Recovery of Neuromuscular Function

Adductor Digiti Minimi

The Train of Four Ratio will be recorded when the adductor pollicis ratio reads 90%

EMG Assessement of Recovery of Neuromuscular Function

Intervention Type: DEVICE

EMG Train of Four Assessment of Recovery of Neuromuscular Function

Interventions

EMG Assessement of Recovery of Neuromuscular Function

EMG Train of Four Assessment of Recovery of Neuromuscular Function

Intervention Type: DEVICE

Eligibility Criteria

Inclusion Criteria

• Surgery and general anesthesia with administration of non depolarizing neuromuscular blocking drug

Exclusion Criteria

• neuromuscular disease or weakness of one of upper limbs.
• Inability to use one of subjects arms to record neuromuscular monitor.
• Contraindication to administration or allergy to non depolarizing neuromuscular blocking drug.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of North Carolina, Chapel Hill

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Stuart Grant

Role: PRINCIPAL_INVESTIGATOR

University of North Carolina, Chapel Hill

Locations

University of North Carolina at Chapel Hill

Chapel Hill, North Carolina, United States

Countries

United States

Other Identifiers

24-1013

Identifier Type: -

Identifier Source: org_study_id