At this year's American Society of Regional Anesthesia and Pain Medicine (ASRA) annual meeting, researchers at Hospital for Special Surgery (HSS) presented three award-winning studies: the first exploring whether the cannabinoid dronabinol can provide pain relief for total knee replacement; the second looking at whether commonly prescribed diabetes or weight loss medications have any effect on gastric emptying and aspiration risk; and the third considering whether spinal anesthesia is safe for patients with a history of Guillain-Barré Syndrome. HSS won two Best of Meeting Abstract awards, as well as a Patient Safety Award, for this research.

“The ASRA research awards recognize HSS’s tireless pursuit of patient safety and innovative treatments in pain management,” said Stavros Memtsoudis, MD, PhD, MBA, Chief of Anesthesiology, Critical Care and Pain Management at HSS and principal investigator of one of the award-winning studies, “Preoperative GLP-1 Agonist Use is Not Associated with Perioperative Aspiration or Pneumonia: A National Observational Study.” “These accolades validate our leadership in research, reinforcing our efforts to enhance safety standards and improve patient outcomes in pain management through evidence-based practices and multidisciplinary collaborations.”

The ASRA Research Committee selects three out of the top 10 highest-scoring scientific abstracts that have met all ASRA Pain Medicine abstract submission requirements and ASRA Pain Medicine membership to be Best of Meeting Abstract winners.

The Patient Safety Award was created in the spirit of Alice Romie to recognize exemplary patient safety work. Alice was an advocate for patient safety who contributed to standardizing medication safety and educating peers about this issue and who passed away from breast cancer in May 2021.

The two Best of Meeting award-winning studies were titled “Effects of Perioperative Dronabinol Use in Total Knee Arthroplasty” and “Preoperative GLP-1 Agonist Use is Not Associated with Perioperative Aspiration or Pneumonia: A National Observational Study.” 

Dronabinol is a synthetic tetrahydrocannabinol (THC) agent that is FDA-approved to treat nausea and vomiting from chemotherapy and to stimulate appetite in patients with HIV or AIDS. Prior studies suggest that cannabinoids may also have pain-relieving properties. While cannabis contains both THC and cannabidiol (CBD), the plant is federally illegal, so it is difficult to study its effects in a hospital setting. As a legal alternative, researchers sought to examine whether 5mg of perioperative dronabinol twice a day could reduce pain and opioid consumption 24 to 48 hours after total knee arthroplasty compared with placebo.

While there were no statistically significant differences in opioid consumption compared with placebo, this study adds to the literature on the effects of THC (in the form of dronabinol) in the perioperative period. Further research examining different dosing regimens of dronabinol for acute pain is warranted.

“In an attempt to decrease perioperative use of opioids in view of the opioid epidemic, it has become even more important to study drugs such as the cannabinoids known to have potential analgesic properties,” said HSS anesthesiologist and lead study author Kethy Jules-Elysee, MD. “Dronabinol was not effective in decreasing pain or opioid consumption in this study with such a rigorous design. However, it was well tolerated. Future studies looking at patients with a history of cannabis use or chronic opioid use should be done, and different dosages of dronabinol should be explored.” Researchers at HSS are also conducting a pilot study examining CBD (Epidiolex) in bilateral total knee replacements.

In the study “Preoperative GLP-1 Agonist Use is Not Associated with Perioperative Aspiration or Pneumonia,” researchers examined whether glucagon-like peptide-1 (GLP-1) medications might affect aspiration or pneumonia risk in patients undergoing surgery. The medications mimic hormones produced in the gut that reduce appetite and cause the body to release insulin, and they are commonly prescribed for diabetes management or weight loss. 

“The increased prescribing of these medications in recent years is likely to result in an increase in patients scheduled for surgery that are on these medications,” said Dr. Memtsoudis. “In a cohort (using MarketScan commercial claims 2017 to 2021 data) of lower extremity joint replacement, hysterectomy, appendectomy and cholecystectomy surgery, preoperative GLP-1 use appears not to be associated with odds of perioperative aspiration or pneumonia. This information may help guide clinical decision-making regarding the use of GLP-1 medications in the preoperative period. However, further research and consideration of broader implications would be necessary before implementing any policy changes.”

In the study that won the 2024 ASRA Patient Safety Award, “Is Spinal Anesthesia Safe in Patients with a History of Guillain-Barré Syndrome Undergoing Orthopedic Surgery?” researchers examined whether regional anesthesia, which has many safety and pain management benefits compared with general anesthesia, is safe for patients with Guillain-Barré syndrome. 

“Guillain-Barré Syndrome (GBS) is a rare autoimmune disorder which results in acute demyelination of the peripheral nervous system, typically after some sort of symptomatic infection,” explained David Lee, MD, an anesthesiologist at HSS and lead study author. “As such, the issue of whether to perform a neuraxial anesthetic technique in these patients has remained a controversial topic due to fears that a spinal may predispose this patient population to worsening neurological symptoms or result in a recurrence of GBS. Because there are many positive benefits to performing a neuraxial anesthetic technique versus general anesthesia, such as decreased mortality, decreased postoperative nausea and vomiting (PONV), and reduced incidence of deep-vein thrombosis, we sought to examine our experience with GBS patients undergoing lower extremity orthopedic procedures over the past 10 years using EPIC to see whether there were any differences in recovery or neurological outcome after administration of a spinal anesthetic.”

In this observational retrospective chart review of 103 patients with a documented history of GBS who underwent some type of lower extremity orthopedic procedure at HSS from 2014 to 2023, 79 patients received a spinal anesthetic and 18 received a general anesthetic. The researchers found no appreciable difference between the groups in postoperative neurological outcomes, length of stay in the post-anesthesia care unit, or length of hospital stay. Similarly, there were also no appreciable differences between the groups in terms of time to achieving physical therapy milestones or incidence of postoperative nausea and vomiting.   

“Because the incidence of GBS is rare (the CDC estimates 3,000 to 6,000 cases per year), the total volume of cases in this study represents a small fraction of the 41,500-plus orthopedic surgeries performed annually at HSS, 85 percent of which are done with a regional anesthetic technique,” said Dr. Lee. “These findings should give both patients and clinicians some measure of assurance that neuraxial anesthetic techniques can be safely performed in someone who has had prior GBS. Larger longitudinal studies would be beneficial to corroborate these findings, so new policies and ASRA guidelines can be established with confidence with regards to the use of neuraxial anesthesia in patients with a prior history of GBS.”

“HSS's commitment to researching new techniques for better outcomes is evident in its dedication to advancing patient care through rigorous scientific inquiry and clinical innovation,” said Dr. Memtsoudis. “By exploring emerging technologies and refining procedural techniques, HSS remains at the forefront of anesthesia administration, pain management, and critical care, ensuring that patients receive the highest standards of care.”

In addition to these three award-winning studies, HSS also presented 20 abstracts and either lectured at or moderated more than 25 sessions, workshops, problem-based learning discussions, poster sessions, and special interest group meetings at this year’s ASRA conference.

References

1. Thor P, Perlstein M, Illescas A, Lauzadis J, Sheetz M, Tailor M, Puglisi A, Popovic M, Oxendine J, Lin Y, Kirksey M, YaDeau J, Kumar K, Baaklini L, Liu J, Cheng S, Mayman D, Jerabek S, Westrich G, Cushner F, Cross M, Sculco P, Sculco T, Ast M, Gonzalez-Della Valle A, Sideris A, Jules-Elysee KM. “Effects of Perioperative Dronabinol Use in Total Knee Arthroplasty.” Presented at: 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), March 21-23, 2024; San Diego, CA.

2. Jashvant Poeran, Yhan Colon Iban, Haoyan Zhong, Alex Illescas, Crispiana Cozowicz, Lisa Reisinger, Jiabin Liu, Stavros Memtsoudis. “Preoperative GLP-1 Agonist Use is Not Associated with Perioperative Aspiration or Pneumonia: A National Observational Study.” Presented at: 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), March 21-23, 2024; San Diego, CA.

3. Tra BM, Haidar J, Lauzadis, J, Illescas A, Lee D. “Is Spinal Anesthesia Safe in Patients with a History of Guillain-Barré Syndrome Undergoing Orthopedic Surgery?” Presented at: 49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), March 21-23, 2024; San Diego, CA.