Louisiana Via Research Day Book 2026

Clinical Research

Clinical Research

105 THE ROLE OF PHARMACOLOGIC MYOSTATIN INHIBITION IN POSTOPERATIVE MUSCLE PRESERVATION AFTER ORTHOPEDIC SURGERY: A NARRATIVE REVIEW

106 ANESTHETIC AND ANALGESIC STRATEGIES FOR HYPERTENSIVE DISORDERS OF PREGNANCY: A STRUCTURED LITERATURE REVIEW

Lee “Allen” Dennis, OMS-III; Cameron Cluney, OMS-III; Matthew Overturf, PhD VCOM-Louisiana

Casey O. Nzeadibe, BS, OMS-III; Kennedi H. Bell, BS, OMS-III VCOM-Louisiana

Context: Postoperative muscle atrophy is a common and clinically significant challenge after orthopedic surgery. Short periods of immobilization can trigger rapid reductions in lean mass and strength, delaying rehabilitation and compromising long-term outcomes. Myostatin (GDF-8) and activin A, ligands in the TGF-ß superfamily, are potent inhibitors of skeletal muscle growth that suppress protein synthesis and enhance proteolysis via Smad2/3 signaling. Elevated activity of these pathways has been associated with muscle wasting in states of immobilization and conditions of disuse. Pharmacologic inhibition of myostatin and activin signaling has therefore been investigated as a therapeutic strategy to attenuate postoperative atrophy and improve functional recovery. Objective: To evaluate whether pharmacologic inhibition of myostatin or activin signaling following orthopedic surgery or immobilization preserves muscle mass and improves functional recovery.

trials in human orthopedic populations and five preclinical animal studies of disuse or ligament injury. Human participants included older adults undergoing elective total hip arthroplasty, surgical repair of hip fracture, and a controlled model of lower limb cast immobilization. Animal models included cast immobilization, ACL transection, and pharmacologic inhibition with a multiligand receptor trap. Outcomes assessed included lean body mass, muscle fiber cross sectional area, contractile function, and clinical performance measures. Results: Across clinical studies, inhibition of myostatin or ActRII consistently increased lean mass, compared to control, but failed to improve postoperative functional recovery which was measured with gait speed, Short Physical Performance Battery scores, stair-climbing, and mobility during immobilization. Preclinical models demonstrated more favorable results. Myostatin inhibition attenuated early muscle loss during hindlimb suspension and casting, reduced catabolic gene expression, preserved fast-twitch fiber area, and partially maintained contractile function. Selective agents such as REGN1033 and ActRIIB

ALK4-Fc produced robust hypertrophy, reduced fibrosis, and improved treadmill endurance. In a rat ACL model, antibody treatment targeting myostatin reduced collagen gene expression and increased fiber size and force significantly. Across models, benefits were most pronounced in the early phase of disuse. Conclusion: Myostatin and activin inhibition reliably increase muscle mass across both human and animal studies. However, functional benefits remain inconsistent in clinical populations, suggesting that pharmacologic hypertrophy alone is insufficient. While muscle hypertrophy provides the structural capacity for strength, the realization of function depends upon neuromuscular re-education, tendon and graft healing, progressive overload stimulus, and psychosocial adherence to rehabilitation protocols. Integration with structured rehabilitation and perioperative timing strategies may be required to translate these anabolic effects into meaningful improvements in postoperative recovery.

Context: Hypertensive disorders of pregnancy contribute significantly to peripartum morbidity and mortality, accounting for ~16% of maternal deaths and 11% of neonatal deaths globally. These conditions create substantial clinical and financial burdens, with maternal and neonatal care costs exceeding $1 billion in the first postpartum year in the U.S. Optimal anesthetic management is essential to mitigate hemodynamic instability and improve perinatal outcomes. This review compiles literature from the past decade on anesthetic and analgesic approaches for pregnant patients with hypertensive disorders. Objective: To identify evidence-supported anesthetic and analgesic practices that optimize maternal hemodynamic stability and neonatal outcomes in patients with hypertensive disorders of pregnancy. Methods: A structured literature review was performed using PubMed and Cochrane Library, focusing on anesthetic and analgesic strategies for women with hypertensive pregnancy disorders, including preeclampsia. Search terms included “hypertensive disorders of pregnancy,”

“preeclampsia,” “neuraxial anesthesia,” “epidural,” “spinal anesthesia,” “general anesthesia,” and “vasopressors.” Inclusion criteria were human studies, English language, and publications within the last 10 years. Exclusion criteria included nonhuman studies, unavailable full text, and non–peer-reviewed publications. Sixteen studies met criteria four systematic reviews/meta-analyses, five randomized controlled trials, six observational studies, and one clinical analysis. Extracted data included anesthetic modality, hemodynamic effects, maternal outcomes, and neonatal parameters, synthesized using standardized spreadsheets. Results: Neuraxial anesthesia was generally safe in preeclamptic parturients and associated with favorable maternal and neonatal outcomes, especially with low-dose spinal or intrathecal techniques. Reduced spinal induced hypotension with bupivacaine and minimal hemodynamic changes with low-dose ropivacaine were observed versus normotensive controls. Vasopressor strategy influenced hemodynamics; norepinephrine preserved heart rate better than phenylephrine with

comparable neonatal outcomes. No technique was universally superior, though continuous spinal anesthesia may provide more consistent cardiovascular stability than epidural analgesia. Adjunct analgesia, including transversus abdominis plane block with intrathecal morphine, improved postoperative pain control without affecting neonatal status. Evidence on vasopressor dosing and general anesthesia safety remains limited, with variability across study populations and methodologies. Conclusion: Evidence supports tailored neuraxial anesthesia with careful vasopressor selection to maintain hemodynamic stability in hypertensive pregnancy disorders. Individualized anesthetic planning based on maternal physiology and resources is essential. Further high-quality studies are needed to define best practices and standardize obstetric anesthesia protocols.

Methods: This review synthesizes findings from eight studies, three randomized controlled

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2026 Research Recognition Day