Current Projects
Sciatic technique comparison of nerve blockade for pain control following hamstring autograft harvest in adolescents
ClinicalTrials.gov Identifier: NCT02947633
The purpose of this research is to compare the effect of single-injection sciatic peripheral nerve blockade (PNB) to continuous sciatic PNB on 1) postoperative pain control as measured by self-reported pain scores, pain medication use, and unplanned hospital admission due to poor pain control, 2) active knee flexion, and 3) patient satisfaction with pain control following ACL reconstruction with a hamstring autograft. The results of this research have the potential to positively impact pain control for the adolescent population undergoing this surgical procedure and foster responsible utilization of limited resources.
Project Goal: To compare the efficacy of single-injection and continuous sciatic peripheral nerve blockade following ACL reconstruction with a hamstring autograft in adolescents.
Funding: American Association of Nurse Anesthetists (AANA) Foundation
Efficacy of nerve blockade performed prior to surgical intervention versus following surgical intervention
ClincialTrials.gov Identifier: NCT02666118
Interscalene brachial plexus blockade is commonly performed to provide relief of postoperative pain following surgical shoulder repair. This has proven to be a reliable means of reducing the required doses of intraoperative and postoperative opiates and effectively delaying postoperative pain, as well as hastening patient discharge and increasing patient satisfaction. Neural blockade has traditionally been performed prior to surgery with the hope that preemptive analgesia will most effectively abate postoperative pain. Recently, however, it has been argued that sensitization to pain can be attributed to many factors, not solely the nociceptive battery associated with incision and subsequent intraoperative events. The duration of action and effectiveness of the treatment modality thus appear play a more important role than the actual timing of the treatment delivered. The safety and efficacy of performing interscalene brachial plexus blockade under general anesthesia has recently been reported as being not only safe, but perhaps more effective than when performed in an awake patient.
Project Goal: To compare the analgesic efficacy of interscalene brachial plexus blockade performed prior to surgery with interscalene brachial plexus blockade performed following the completion of surgery in healthy ASA I and II adolescent patients undergoing unilateral shoulder reconstruction on an outpatient basis.
Funding: Avanos Medical, Inc.
Does montelukast decrease post adenotonsillectomy pain in children? A randomized controlled trial.
ClinicalTrials.gov Identifier: NCT02793375
Adenotonsillectomy (T&A) is the one of the most common pediatric procedures performed in the United States, with over 530,000 procedures performed annually. Pain control after T&A is essential for improving recovery and enhancing quality of life. At Cincinnati Children's Hospital Medical Center, our current protocol in patients over the age of three is to treat pain with scheduled acetaminophen, ibuprofen and steroids, as well as opioids (oxycodone) as a "rescue" medication for uncontrolled pain. Despite this regimented approach, pain control is often suboptimal, and numerous doses of opioids are often required. Montelukast is a cysteinyl leukotriene receptor antagonist that may have a role in decreasing post T&A pain. The primary objective of the present study is to evaluate the effect of montelukast on post-T&A pain by measuring the amount of opioid pain medication required postoperatively in patients receiving montelukast preoperatively compared to those receiving placebo. The secondary objective will evaluate post-surgical outcomes and include group comparisons of post T&A pain scores and number of Emergency department visits and/or phone calls for perioperative pain related complaints.
Project Goal: To compare the efficacy of montelukast in controlling postoperative pain following adenotonsillectomy in pediatric patients.
Funding: Cincinnati Children's Hospital Medical Center
Adductor canal blockade (ACB) for pain control after medial patellofemoral ligament (MPFL reconstruction)
Surgical medial patellofemoral ligament (MPFL) reconstruction is often employed to prevent continued episodes of dislocation, but currently there is no agreed upon consensus regarding best practice for pain management following this painful procedure. Although femoral nerve blockade (FNB) has long been considered the gold standard for providing analgesia to the anterior aspect of the lower extremity, it may ultimately prove detrimental to long-term outcomes following MPFL reconstruction. FNB impedes motor function; specifically, extension of the lower extremity at the knee. Short- and long-term follow-up studies report residual extensor lag as a common issue following MPFL reconstruction. Interference of FNB with early postoperative motion may be a critical barrier to recovery. First, early postoperative motion may reduce pain by a classic, gate-control like mechanism where motion engages large diameter low threshold mechanoreceptive afferents that activate a mechanism that inhibits nociceptive input from small diameter afferents. Moreover, early motion may promote healthy development of cartilage and periarticular tissues, and prevent scar formation and capsular contractions. While the analgesic efficacy of adductor canal blockade (ACB) has been argued to be inferior to FNB it is increasingly employed over FNB as it does not impact the extensor mechanism of the lower extremity. It is not known if the motor-sparing effect of ACB diminishes the prevalence of undesired long-term outcomes such as residual extensor lag, limited range of motion, and chronic pain; all of which are associated with increased opioid consumption.
Project Goal: To determine if the motor-sparing effect of adductor canal blockade (ACB) fosters return of early motion and its concomitant benefits while providing adequate postoperative pain management.
Funding: Not currently funded
Brain-based markers to predict trajectory of recovery following adolescent anterior cruciate ligament (ACL) repair
Neurologic signatures or patterns of activity across brain regions derived from functional magnetic resonance imaging (fMRI) have the potential to provide predictive measures of trajectory of recovery which could accelerate identification of patients at risk for developing chronic pain following ACL reconstruction. The development chronic pain postoperatively can be secondary to a host of factors, among them poor compliance with OT/PT. Often times, poor compliance with OT/PT is secondary to the fear of pain associated with movement of the reconstructed extremity. Kinesiophobia, or the fear of pain due to movement, can impede compliance with OT/PT following surgery resulting in decreased range of motion and alterations in mobility patterns. The use of fMRI to guide treatment of patients with chronic pain is well founded, however, to date there have been no randomized, prospective trials exploring the use of fMRI for predictive modeling in adolescents facing periods of severe acute pain. Nonetheless, several areas of the brain have been implicated in being engaged in acute pain. Among them are the anterior cingulate (ACC) and insular (IC) cortices. The insular cortex has been shown to be modified by the direct action of opioids and the ACC is activated is fMRI studies exploring acute pain and placebo effects. The insular appears to play a role in modulating cognitive cortical functions involved in the appraisal of pain.
Project Goal: To determine if fMRI can be used an objective tool for predictive modeling of acute pain outcomes.
Funding: Not currently funded
