Clinical Research Seed Awards

The Department of Anesthesia and Perioperative Care is strongly committed to supporting translational and clinically-oriented research in a variety of topics related to the perioperative sciences, and to the continued growth of our clinically-oriented research program. In order to facilitate the research being performed in the Department, we solicit applications for funding via a yearly Request for Applications (RFA). The goal of the RFA program is to provide limited funding to facilitate, promote, or sustain research by members of the Department of Anesthesia Faculty.

Awarded Projects: 2019-2020

 

Principle Investigator: Wilson Cui, MD, PhD – Assistant Clinical Professor

Project Title: Erector Spinae Plane Block for Minimally Invasive Mitral Valve Surgery

Project Summary: The goal of our project is to study whether local anesthetic via the erector spinae plane (ESP) block may be beneficial in minimally invasive mitral valve surgery (MIMVS). ESP is a new fascial plane nerve block that was first used as a safe treatment for chronic chest pain. Its analgesic effect is similar to well-established blocks such as the paravertebral block and epidural analgesia. Yet in contrast to the latter two techniques, the needle and catheter in a ESP block are more superficial and farther away from vessels and nerve plexi. It is considered by experts to have lower risk of bleeding and other potential complications. 

 

MIMVS avoids sternotomy in favor of smaller thoracotomy incisions. It has been shown to have less blood loss, faster extubation, less postoperative pain and shorter ICU and hospital stay. Current analgesia plan involves the use of intravenous opioids and non-opioid adjuncts, cryoablation of intercostal nerves and the injection of liposomal local anesthetics. The evidence on the use of ESP block in the cardiothoracic surgical patients is limited so far. Our project hope to determine whether there is an additional benefit on ESP block in MIMVS compare to the current pain management.   

 

Principle Investigator: Claas Siegmueller, MD, PhD, MBA – Associate Clinical Professor

Project Title: Bilateral erector spinae plane blocks (ESP) for postoperative pain in lumbar spine surgery: A double-blinded randomized controlled trial

Project Summary: The goal of this study is to evaluate the analgesic efficacy of bilateral erector spinae plane (ESP) blocks after lumbar and lumbo-sacral spine surgery by assessing postoperative pain scores and opiate requirements as the primary outcome measures. We are aiming to investigate how ESP blocks, performed under ultrasound guidance at the T12 vertebral level, contribute to postoperative pain control. This will be determined by measuring numerical rating pain scores following surgery and perioperative opiate consumption until patient discharge from hospital. These primary outcome measures will be compared between a treatment group of participants, who will receive ESP blocks and a control group who will receive a sham block.

 

Our primary hypothesis is that ESP blocks significantly reduce postoperative pain and opiate requirements. Recently published early evidence from several case reports, small case series and two small randomized-controlled trials suggests that bilateral ESPs can reduce postoperative pain after lumbar spine surgery.

 

Principle Investigator: Becky Tsui, MD – Assistant Clinical Professor

Project Title: Evaluation of the existence of RNA species in the epidural space and their association with pain pattern

Project Summary: The pathophysiology of acute and chronic pain remains an elusive and complex frontier in clinical biology.  Many research studies have shown an association between circulating micro-RNAs in blood and pain syndromes, but these are likely systemic responses to pain states. There is currently no data as to whether there are any micro-RNAs or mRNA fragments that exist in the epidural space which may shed more light on a neurologic basis that could relate to specific pain states. We hypothesize that neuronal-specific RNA species can be detected in the epidural space, and these RNA signatures may be associated with pain patterns.  The goal of this study is to collect RNA fragments from thoracic epidural catheters at the time of removal and perform RNA sequencing to identify neuronal RNA species that may exist in the epidural space. The targeted subject populations are 1) patients with postoperative pain, 2) patients with traumatic injuries, such as rib fractures, that are amenable to epidural analgesia. In the future, if transcripts can be detected, and paired with the patients’ medical record, we could, with sufficient input, develop signatures that are predictive for a patient’s response to therapeutic analgesia. By interrogating the epidural space for neuronal RNA biomarkers, we could develop a novel diagnostic approach that could be applicable to acute and chronic pain syndromes and potentially alter management.