Sugammadex vs Neostigmine/Glycopyrrolate on Urinary Retention After Spine Surgery
A Double-blind, Randomized, Parallel Group Study to Compare Rocuronium Reversal With Sugammadex (Bridion®) Versus Neostigmine/Glycopyrrolate and the Incidence of Urinary Retention After Elective Ambulatory Posterior Lumbar Laminectomy
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 4
Contacts and Locations
Study Contact
Study Contact
- Name: Boris Mraovic, MD, FASA
- Phone Number: 573-882-2568
- Email: mraovicb@health.missouri.edu
Study Locations
-
-
Missouri
-
Columbia, Missouri, United States, 65212
- University Hospital
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≥ 18 years
- ASA Physical Status I-III
Exclusion Criteria:
- Inability to obtain written informed consent
- Allergy to medications used in the protocol
- Known or suspected neuromuscular disorders
- Significant renal disease with a serum creatinine ≥ 2 mg/dL
- Significant liver disease
- A family history of malignant hyperthermia
- History of genitourinary surgery, cancer, or radiation within the last year
- Currently prescribed urological medications or diuretics
- BPH or symptoms of BPH (interrupted or weak urine stream or wake up to urinate more than two times per night)
- History or diagnosis of urinary incontinence or urinary retention
- History of PONV with use of scopolamine
- Use of Foley catheter pre- or intra- operatively
- Perioperative medications that influence micturition (e.g., diuretics or intraoperative anticholinergic medication use other than NMB reversal)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Quadruple
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Sugammadex 2 mg/kg
Sugammadex 2 mg/kg administered as a single intravenous (IV) dose.
|
Sugammadex will be used to reverse rocuronium neuromuscular blockade (NMB).
Dose will be according to participant actual body weight.
Other Names:
To achieve NMB, participants will receive the steroidal neuromuscular blocking agent Rocuronium Bromide administered via IV infusion and dosed according to participant actual body weight.
It will be used per label to maintain muscle relaxation as an adjunct to general anesthesia.
Other Names:
|
|
Active Comparator: Neostigmine + Glycopyrrolate
Neostigmine 50 μg/kg (up to 5 mg maximum dose) plus glycopyrrolate 10 μg/kg (up to 1 mg maximum dose) administered as a single IV dose.
|
To achieve NMB, participants will receive the steroidal neuromuscular blocking agent Rocuronium Bromide administered via IV infusion and dosed according to participant actual body weight.
It will be used per label to maintain muscle relaxation as an adjunct to general anesthesia.
Other Names:
Neostigmine will be used to reverse rocuronium NMB.
Dose will be according to participant actual body weight.
Other Names:
Glycopyrrolate will be co-administered with neostigmine during reversal of rocuronium NMB.
Dose will be according to participant actual body weight.
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Incidence of urinary retention
Time Frame: Up to 6 hours after administration of study intervention
|
The difference between sugammadex and neostigmine/glycopyrrolate on the incidence of urinary retention defined as no void more than 6 hours after posterior lumbar spine surgery in ambulatory/short stay patients.
|
Up to 6 hours after administration of study intervention
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Micturition
Time Frame: Up to 1 day after administration of study intervention
|
Between patients who received sugammadex and neostigmine/glycopyrrolate.
To compare actual times of micturition we will analyze the proportion of patients (percentages) voided at 6, 9, 12 and 24 hours.
|
Up to 1 day after administration of study intervention
|
|
Bladder urine volume
Time Frame: Up to 6 hours after administration of study intervention
|
Between patients who received sugammadex and neostigmine/glycopyrrolate.
To compare bladder urine volumes in milliliters (mL) we will perform bladder ultrasound scan at 6 hours postoperatively if patients did not void.
|
Up to 6 hours after administration of study intervention
|
|
Urinary retention symptoms
Time Frame: Up to 1 day after administration of study intervention
|
Between patients who received sugammadex and neostigmine/glycopyrrolate.
To compare urinary retention symptoms, we will administer a questionnaire at 6 hours postoperatively and on postoperative day 1.
|
Up to 1 day after administration of study intervention
|
|
Bladder catheterization
Time Frame: Up to 1 Day after administration of study intervention
|
Between patients who received sugammadex and neostigmine/glycopyrrolate.
To compare need for bladder catheterization (straight or Foley).
|
Up to 1 Day after administration of study intervention
|
|
Length of hospital stay
Time Frame: Up to 7 Days after administration of study intervention
|
Between patients who received sugammadex and neostigmine/glycopyrrolate.
To compare length of hospital stay.
|
Up to 7 Days after administration of study intervention
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Boris Mraovic, MD, FASA, University of Missouri-Columbia
Publications and helpful links
General Publications
- Baldini G, Bagry H, Aprikian A, Carli F. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009 May;110(5):1139-57. doi: 10.1097/ALN.0b013e31819f7aea.
- McLain RF, Kalfas I, Bell GR, Tetzlaff JE, Yoon HJ, Rana M. Comparison of spinal and general anesthesia in lumbar laminectomy surgery: a case-controlled analysis of 400 patients. J Neurosurg Spine. 2005 Jan;2(1):17-22. doi: 10.3171/spi.2005.2.1.0017.
- Chang Y, Chi KY, Tai TW, Cheng YS, Lee PH, Huang CC, Lee JS. Risk factors for postoperative urinary retention following elective spine surgery: a meta-analysis. Spine J. 2021 Nov;21(11):1802-1811. doi: 10.1016/j.spinee.2021.05.009. Epub 2021 May 18.
- Cremins M, Vellanky S, McCann G, Mancini M, Sanzari L, Yannopoulos A. Considering healthcare value and associated risk factors with postoperative urinary retention after elective laminectomy. Spine J. 2020 May;20(5):701-707. doi: 10.1016/j.spinee.2020.01.012. Epub 2020 Jan 29.
- Cha JE, Park SW, Choi YI, et al. Sugammadex use can decrease the incidence of post-operative urinary retention by avoiding anticholinergics: a retrospective study. Anesthesia and Pain Medicine. 2018;13(1):40-46.
- Zakaria HM, Lipphardt M, Bazydlo M, Xiao S, Schultz L, Chedid M, Abdulhak M, Schwalb JM, Nerenz D, Easton R, Chang V; MSSIC Investigators. The Preoperative Risks and Two-Year Sequelae of Postoperative Urinary Retention: Analysis of the Michigan Spine Surgery Improvement Collaborative (MSSIC). World Neurosurg. 2020 Jan;133:e619-e626. doi: 10.1016/j.wneu.2019.09.107. Epub 2019 Sep 27.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Urogenital Diseases
- Male Urogenital Diseases
- Urologic Diseases
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urination Disorders
- Urinary Retention
- Organic Chemicals
- Heterocyclic Compounds, 1-Ring
- Heterocyclic Compounds
- Carbohydrates
- Polycyclic Compounds
- Amines
- Steroids
- Fused-Ring Compounds
- Polysaccharides
- Androstanes
- Macrocyclic Compounds
- Phenylammonium Compounds
- Quaternary Ammonium Compounds
- Onium Compounds
- Pyrrolidines
- gamma-Cyclodextrins
- Cyclodextrins
- Dextrins
- Starch
- Glucans
- Androstanols
- Rocuronium
- Glycopyrrolate
- Neostigmine
- Sugammadex
Other Study ID Numbers
Other Study ID Numbers
- 2096001
- MISP Database number 101357 (Other Identifier: Merck Sharp & Dohme LLC)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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