Median Nerve Electromyography to Monitor Intraoperative Neuromuscular Function

Comparative Examination of Ulnar and Median Nerve Electromyography Examinations to Monitor Intraoperative Neuromuscular Function

The effect of muscle relaxants need to be followed during surgery and before waking up the patient, the anesthesiologist has to make sure that the effect of muscle relaxants is gone. For this purpose, anesthesiologists use so called objective neurlmuscular monitors. These monitors stimulate the ulnar nerve in the wrist and examine the evoked muscle response. The aim of this study is to examine the usability of another nerve in the wrist, the median nerve.

Study Overview

• Status: Not yet recruiting
• Conditions: Elective Surgery; Neuromuscular Monitoring After Administration of Neuromuscular Blocking Agents in Different Types of Surgery; Nerve Conduction Study
• Intervention / Treatment: Diagnostic test: Electromyography

• Study Type: Observational
• Enrollment (Estimated): 45

Contacts and Locations

• Study Contact: Name: Reka Nemes, MD PhD; Phone Number: +36 30 966 8722; Email: nemes.reka@med.unideb.hu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult patients undergoing elective surgery that requires one dose of non-depolarising neuromuscular blocking agent, whose arms are accessible for intraoperative neuromuscular blockade monitoring.

Description

Inclusion Criteria:

• ASA I-III physical status
• elective surgery requiring muscle relaxation
• both arms are available during surgery in the same position for neuromuscular blockade monitoring
• signed informed consent form

Exclusion Criteria:

• neruomuscular disorder in patient history (eg. stroke, myasthenia)
• innervation problem in either arms (eg. carpal tunnel syndrome)
• deformity to either arms (eg. Dupyurten contracture, severe arthritis)
• Severe hepatic or renal insufficiency that affects muscle relaxant pharmacokinetics
• skin lesions at the site of electrode placement
• implanted pacemaker jelenléte
• gravidity
• muscle relaxant needs to be repeated during surgery

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Median nerve examination; Median nerves in the dominant and non-dominant hands are are examined	Diagnostic test: Electromyography; Electromyographic examination of the median and ulnar nerves to monitor intraoperative neuromuscular blockade
Ulnar nerve examination; Ulnar nerves in the dominant and non-dominant hands are examined	Diagnostic test: Electromyography; Electromyographic examination of the median and ulnar nerves to monitor intraoperative neuromuscular blockade

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
CMAP	Comparison of compound muscle action potential amplitudes evoked by median and ulnar nerve stimulation and measured at the thenar	Baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Recovery time	Time from muscle relaxant administration to spontaneous recovery to TOFR>0,9 monitored with median and ulnar nerve stimulation	Perioperative
Onset time	Time from administration of muscle relaxant to disappearance of twitch response (TOFC0) monitored with median and ulnar nerve stimulation	Baseline

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Bland-Altman analysis of TOFRs	Bland-Altman analysis of TOFRs obtained with medin and ulnar nerve stimulation	Intraoperative
Bland-Altman analysis of TOFCs	Bland-Altman analysis of TOFCs obtained with median and ulnar nerve stimulation	Intraoperative
Bland-Altman analysis of PTCs	Bland-Altman analysis of PTCs obtained with median and ulnar nerve stimulation	Intraoperative
Baseline TOFRs	Examination of the stability of baseline TOFRs obtained with median and ulnar nerve stabilization	Baseline
Comparison of CMAP amplitudes obtained from dominant and non dominant hands	Comparison of CMAP amplitudes obtained from dominant and non dominant hands evoked my median and ulnar nerve stimulation	Baseline

Collaborators and Investigators

• Sponsor: Pongrácz Adrienn

Study record dates

Study Major Dates

• Study Start (Estimated): April 27, 2026
• Primary Completion (Estimated): March 31, 2028
• Study Completion (Estimated): March 31, 2028

Study Registration Dates

• First Submitted: April 21, 2026
• First Submitted That Met QC Criteria: May 4, 2026
• First Posted (Actual): May 6, 2026

Study Record Updates

• Last Update Posted (Actual): May 6, 2026
• Last Update Submitted That Met QC Criteria: May 4, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: median nerve; electromyography; neuromuscular blockade monitoring
• Additional Relevant MeSH Terms: Diagnostic Techniques and Procedures; Diagnosis; Electrodiagnosis; Myography; Electromyography
• Other Study ID Numbers: AITT 2026/1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No