The Immunomodulatory Effect of Sugammadex After Total Hip Replacement Surgery Under Neuraxial Anaesthesia: a Pilot Study

Phase 2

Completed

• Conditions: Innate Inflammatory Response; Osteoarthritis, Hip
• Interventions: Other: Placebo; Drug: Sugammadex 100 MG/ML [Bridion]

• Registration Number: NCT05723406
• Lead Sponsor: Radboud University Medical Center

Brief Summary

Monocenter randomized controlled proof of principle study to investigate the effect of sugammadex at the end of total hip replacement surgery on the postoperative innate immune function

Detailed Description

Rationale: With infections being the number one complication after surgery, more research is aimed at therapeutic strategies that positively influence the postoperative immune dysregulation. In the search for reducing surgical stress by a deep neuromuscular block (NMB), our group recently found evidence that sugammadex, used to antagonize a deep NMB, may have an immunomodulatory effect. Ex vivo analysis showed that sugammadex counteracted the immunosuppressive effect of rocuronium, but even in absence of rocuronium it had a positive effect on cytokine production capacity.

Therefore, we now propose a clinical pilot study in patients planned for total hip surgery under neuraxial anaesthesia to further investigate whether sugammadex has beneficial immunomodulatory effects.

Primary objective: To investigate the effect of sugammadex on the postoperative innate immune function.

Study design: A blinded, randomized controlled pilot study

Study population: 20 adults scheduled for primary hip replacement surgery under neuraxial anaesthesia.

Intervention: Patients will be randomized between a group receiving sugammadex at the end of surgery and a group receiving placebo.

Primary endpoint: Postoperative innate immune function as reflected by ex vivo mononuclear cell cytokine production capacity upon whole blood lipopolysaccharide (LPS) stimulation.

Secondary endpoint: Postoperative innate immune function as reflected by DAMP release and circulating inflammatory cytokines, Quality of Recovery score (QoR-40) postoperative day 1, postoperative pain and analgesia consumption, 30-day postoperative (infectious) complications

Study Timeline

• Status Verified: 2023-01
• Study First Submitted: 2023-01-27
• Study First Submitted QC: 2023-02-08
• Study First Posted: 2023-02-10
• Study Start: 2023-03-21
• Primary Completion: 2023-11-23
• Study Completion: 2023-11-23
• Last Update Submitted: 2023-11-27
• Last Update Posted: 2023-11-28

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 20

Inclusion Criteria

• Age of 18 years or older
• Scheduled for total hip replacement surgery under neuraxial anesthesia
• Scheduled for primary hip replacement surgery
• Informed consent obtained

Exclusion Criteria

• Insufficient control of the Dutch language to read the patient information and to fill out the questionnaires
• Mentally incapacitated patients
• Known or suspected hypersensitivity to sugammadex
• Deficiency of vitamin K dependent clotting factors or coagulopathy
• Severe renal disease (creatinine clearance <30 ml/min), including patients on dialysis)
• Severe liver disease (Child-Pugh Classification C)
• Women who are or may be pregnant or currently breastfeeding
• Women of childbearing potential who don't use adequate method of contraception
• Severe vertebral column disorder
• Chronic use of psychotropic drugs
• Known hypertrophic obstructive cardiomyopathy, severe aortic valve stenosis or severe mitral valve stenosis
• Chronic use of NSAID's, steroids or immunosuppressive drugs

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo	Placebo	Placebo administration at the end of surgery
Sugammadex	Sugammadex 100 MG/ML [Bridion]	Sugammadex administration at the end of surgery

Primary Outcome Measures

Name	Time	Method
Postoperative innate immune function	Postoperative day 1	Ex vivo cytokine production capacity (TNF-α, IL-6, IL-10, IL-1β) of mononuclear cells upon whole blood Lipopolysaccharide(LPS) stimulation

Secondary Outcome Measures

Name	Time	Method
Postoperative innate immune function	3 timepoints: Postoperative day 1, at the start of surgery (±30 minutes after administration neuraxial anesthesia), and at the end of surgery (±15 minutes after administration intervention/placebo medication)	Danger associated molecular pattern (DAMP) release (Heat shock protein 70 (HSP 70), High mobility group box 1 (HMGB1))
Postoperative complications	Postoperative day 30	postoperative complications scored by Clavien-Dindo classification; grade 0 (no deviation from ideal) grade 5 (death of patient)
Pain and total analgesia consumption	During hospital admission up to 3 days postoperative	Pain scores by numeric rating scale (NRS 0-10)
Postoperative infectious complications	Postoperative day 30	Postoperative infectious complications scored the definitions of the StEP-COMPAC group initiative
Quality of Recovery	Postoperative day 1	Quality of Recovery 40 (QoR-40) validated questionnaire score. 40 points (minimum: extremely poor quality of recovery) to 200 points (maximum: excellent quality of recovery)

Trial Locations

Locations (1)

Radboudumc; 🇳🇱 Nijmegen, Netherlands