Auburn Research Day 2021

Cl i n i ca l Resea rch | Med i ca l St udent Intraoperative Pain Management in Spinal Tumor Ablations Improves Postoperative Recovery

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Caroline G. Pupke; Sara Wallace; Nathan J. Neufeld, DO Edward Via College of Osteopathic Medicine-Auburn; Cancer Treatment Centers of America

Objectives: Postoperative pain is a significant adverse outcome reported by patients following surgical procedures. Multimodal analgesia is currently recommended for effective postoperative pain control and has been shown to decrease the requirement for postoperative analgesics. This study examines the administration of multiple different analgesics intraoperatively during a vertebral augmentation with radiofrequency ablation and how these analgesics affect pain medication consumption postoperatively, as well as length of stay in the postoperative anesthesia care unit (PACU). Design: The study included 28 patients undergoing vertebral augmentation with radiofrequency ablation. Of these patients, 13 patients were administered 8mg of Decadron, 1g of IV Tylenol, 30mg of Toradol, and 1g of Robaxin intraoperatively. The remainder of the patients were not given the complete medication regimen due to various contraindications. Patients who were not given the medication regimen intraoperatively were considered our control group. The patients were monitored postoperatively in the PACU.

Pain medication consumption, as well as length of stay in the PACU were recorded by PACU nurses. Results: 81% of the patients that didn’t need additional pain medication in the PACU were given the full 4-drug medication regimen intraoperatively. 68% of the patients who stayed less than an hour in the PACU were administered all 4 medications intraoperatively. All 13 patients that received the 4-drug medication regimen intraoperatively stayed in the PACU less than an hour and did not need to be administered additional pain medication in the PACU. Conclusions: From this study, we concluded that administering our 4-drug regimen intraoperatively during a vertebral augmentation with radiofrequency ablation reduces consumption of pain medication postoperatively and decreases PACU recovery time. Decreasing the need for additional pain medications postoperatively can decrease the risk of side effects and drug interactions, especially in cancer patients taking multiple classes of drugs.

Cl i n i ca l Case Repor t | Med i ca l St udent Radiofrequency Ablation and Vertebroplasty of Cervical Metastatic Lesion: A Novel Anterior Approach

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Subtitle: Introduction: The case of a 63-year-old male with lymphoma and an anterior C7 metastatic lesion treated in a novel fashion using the combination of radiofrequency ablation and cement vertebroplasty using an anterior cervical approach is reported. The patient was considered for this treatment after failing narcotics management for pain. The typical approach for bone tumor ablation in the vertebral bodies is done bi-pedicular and posteriorly. However, in the cervical spine the pedicles are very small, and the vertebral artery runs through the transverse processes causing increased risk and difficulty with a posterior approach. Therefore, with the help of neurosurgery we decided to attempt an anterior neck open vertebral access to ablate the tumor. Methods: Computed tomography and positron emission tomography scans of the cervical spine revealed metastasis to the body of the C7 vertebra. Pre-procedural pain was rated as 7/10. The access to the anterior surface of the C7 vertebra was accomplished by making an initial incision of the anterior cervical area and dissecting down through the soft tissue. The platysma muscle was then opened in a superior-to-inferior fashion. The prevertebral soft tissue was then dissected in routine fashion exposing the anterior spinal anatomy. The longus coli muscles were dissected off the vertebral body and a retractor was placed for exposure. The area Nathan J. Neufeld, DO; J. Blair Davis, OMS-III; Said Elshihabi, MD Cancer Treatment Centers of America

of the tumor was approximately 7mm x 5mm in the anterior inferior left corner of the C7 vertebra. After seating of the trocar in the periosteum, a measurement drill was used to prepare a canal for the ablation probe. Radiofrequency ablation was performed using a bipolar single needle with a temperature setting of 80 degrees Celsius for six minutes. A cement vertebroplasty was then performed without complications. Results: After completion of the procedure, the patient’s pain was completely resolved and rated as 0/10. Computed tomography and positron emission tomography scans taken four months after the procedure demonstrated complete resolution of the lesion. Conclusion: For the cervical spine where vertebral metastasis is painful, and anterior open approach for vertebral augmentation with bone tumor ablation can be performed is safe and possible to reduce symptoms and tumor burden locally. However, further study would be advised to purse this technique in all circumstances.

13 2021 Via Research Recognit ion Day