New Study: Vocacapsaicin Reduces Pain and Opioid Use After Bunionectomy

Topline: Administration of vocacapsaicin during bunionectomy significantly reduces pain and decreases opioid consumption in the first 96 hours after surgery, with no observed local or systemic toxicity compared to placebo.

Methodology: This triple-blinded, randomized, placebo-controlled trial included 147 patients undergoing bunionectomy. Patients were randomly assigned to receive 14 mL of either 0.05 mg/mL vocacapsaicin, 0.15 mg/mL vocacapsaicin, 0.30 mg/mL vocacapsaicin, or placebo at the surgical site during wound closure. All patients received identical perioperative analgesics except for the study drug.

Patients were monitored for 96 hours post-surgery, with follow-up visits on days 8, 15, and 29 to assess pain and adverse events. The primary endpoint was overall levels of pain at rest through the first 96 hours after surgery for the 0.30 mg/mL vocacapsaicin group. Secondary endpoints included the percentage of patients not requiring opioids, total opioid consumption through 96 hours, and pain scores during the first postoperative week.

Takeaway: Vocacapsaicin at a concentration of 0.30 mg/mL reduced pain at rest by 33% over the first 96 hours compared to placebo (P = .005). Additionally, 26% of patients receiving the 0.30 mg/mL dose did not require opioids through 96 hours, compared to 5% of placebo patients (P = .025). The largest dose of vocacapsaicin also resulted in a 50% reduction in opioid consumption over the first 96 hours (P = .002) and a 37% reduction in pain at rest during the first week post-surgery (P = .004).

No differences were observed in the rate, type, or severity of adverse events among the four study groups, indicating typical recovery from bunionectomy.

In Practice: “These data suggest that intraoperative administration of vocacapsaicin may provide substantial benefits in other surgical procedures,” the authors wrote.

Source: The study was led by Steven L. Shafer, MD, of the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University in Stanford, California, and published in the June 2024 issue of Anesthesiology.

Edited by Shrabasti Bhattacharya. Vocacapsaicin Reduces Pain and Opioid Use Post-Surgery — Medscape — July 08, 2024.