Surgeon-Delivered Nerve Block for Reduction of Perioperative Pain and Opioid Use After Lumbosacral Spine Surgery

Joiner, Evan F.; Neira, Justin A.; Yevudza, Wisdom E; Weller, Mark A; Wagener, Gebhard; Angevine, Peter D.; Mandigo, Christopher E.

doi:10.1001/jamanetworkopen.2022.48439

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…Needle interventions play an irreplaceable role in the promotion of clinical diagnosis and management, including needle biopsy, nerve block, and effusion aspiration. − During needle interventions, the application of ultrasound-guided puncture enables visualization of dynamic anatomy and allows for real-time observations of needle placement. , These visual improvements significantly improve the success rate and minimize the unexpected lesions. − However, needle interventions highly rely on physicians’ experience due to the low contrast between the needle and the noisy background, which is unavoidable.…”

Section: Introductionmentioning

confidence: 99%

Practical Electrochemical Method to Enhance Needle Visibility during Ultrasound Imaging

Chen,

Zhang,

et al. 2023

ACS Biomater. Sci. Eng.

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Ultrasound-guided needle interventions play a pivotal role in the diagnosis and treatment processes in clinical practice. However, existing echogenic needles face challenges in achieving a balance between effectiveness, ease of manufacturing, and inexpensiveness. In this study, we developed an echogenic needle that encompassed the aforementioned advantages through the use of the electrolysis technology. The overall contour of the needle after electrolysis was observed using bright-field microscopy, while scanning electron microscopy (SEM) was employed to examine the micro-variations on the needle's surface. Subsequently, we validated the enhanced visualization effects in vitro (pork) and in vivo (anesthetized rabbit's thigh) puncture phantoms. To ensure the safety of the needles after the puncture procedure, we conducted Vickers hardness tests, SEM detection, bright-field microscopy, and DAPI staining. The results demonstrated that the surface roughness of the needle increased with the duration of electrolysis. Taking into account the comprehensive safety tests, the needle, subjected to 40 s of electrolysis, demonstrated a safe and effective enhancement of ultrasound visualization.

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Section: Introductionmentioning

confidence: 99%

Practical Electrochemical Method to Enhance Needle Visibility during Ultrasound Imaging

Chen,

Zhang,

et al. 2023

ACS Biomater. Sci. Eng.

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“…Effective management of pain after surgery is an unmet medical need. 1–5 Oral opioid analgesics remain an integral part of postsurgical pain management 1,2 despite common side effects, safety concerns, and the risk of persistent opioid use. 6–8 Acute side effects can interfere with recovery, whereas persistent opioid use has risks to both the patient and overall public health.…”

mentioning

confidence: 99%

Safety and Efficacy of Vocacapsaicin for Management of Postsurgical Pain: A Randomized Clinical Trial

Shafer,

Teichman,

Gottlieb

et al. 2024

Anesthesiology

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Background Nonopioid management of postsurgical pain remains a major unmet need. Few studies have evaluated TRPV1 agonists for analgesia after surgery. We studied intraoperative vocacapsaicin, a novel prodrug of the TRPV1 agonist capsaicin, in a validated model of postsurgical pain. Methods This was a triple-blinded, randomized, placebo-controlled, dose-ranging trial in patients undergoing bunionectomy. We randomized patients 1:1:1:1 to surgical site administration of 14 mL of placebo or one of three vocacapsaicin concentrations: 0.30, 0.15, or 0.05 mg/mL. The prespecified primary endpoint was the area-under-the-curve of the Numerical Rating Scale (NRS) pain score at rest through 96 hours for the 0.3 mg/mL group. Prespecified ordered, secondary endpoints for the 0.3 mg/mL group included percent of patients who did not require opioids from 0-96 hours, total opioid consumption through 96 hours, and the area-under-the-curve of the NRS pain score for the first week. Results We randomized 147 patients. During the first 96 hours, vocacapsaicin 0.30 mg/mL reduced pain at rest by 33% vs. placebo (primary endpoint, 95% CI [10%, 52%], effect size (Cohen’s D) = 0.61, p = 0.005). Twenty-six percent of patients receiving vocacapsaicin 0.30 mg/mL did not require postoperative opioids for analgesia (p=0.025) vs. 5% of patients receiving placebo. Vocacapsaicin 0.30 mg/mL reduced opioid consumption over the first 96 hours by 50% vs. placebo (95% CI [26%, 67%], effect size = 0.76, p = 0.002). Vocacapsaicin 0.30 mg/mL reduced pain over the first week by 37% vs. placebo (95% CI [12%, 57%], effect size = 0.62, p = 0.004). Treatment effect persisted for at least 2 weeks. All study endpoints showed an administered concentration vs. response relationship. Vocacapsaicin was well-tolerated with no differences between groups in any safety parameter. Conclusions A single, local administration of vocacapsaicin during surgery reduced pain and opioid consumption for at least 96 hours after surgery compared to control. Trial Registration ClinicalTrials.gov NCT03599089

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Surgeon-Delivered Nerve Block for Reduction of Perioperative Pain and Opioid Use After Lumbosacral Spine Surgery

Abstract: This cohort study compares postoperative pain scores, opioid use, and length of hospital stay among adults undergoing noninstrumented lumbosacral surgery who received x-ray–guided dorsal ramus block vs those who did not.

Cited by 2 publications

References 7 publications

Practical Electrochemical Method to Enhance Needle Visibility during Ultrasound Imaging

Practical Electrochemical Method to Enhance Needle Visibility during Ultrasound Imaging

Safety and Efficacy of Vocacapsaicin for Management of Postsurgical Pain: A Randomized Clinical Trial

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