Jin Yoo

Craniofacial and corneal neuropathic pain are disabling conditions characterized by persistent pain that is frequently refractory to conventional pharmacologic and interventional therapies. These disorders arise from complex interactions between peripheral nerve injury, neuroinflammation, and maladaptive central sensitization within trigeminal pathways, features that span neuropathic and nociplastic pain mechanisms as defined by the International Association for the Study of Pain, thus emphasizing the need for mechanism-based, patient-stratified treatment strategies. Regenerative medicine offers a paradigm shift from symptom suppression toward structural nerve repair and functional restoration. This narrative review examines the pathophysiological mechanisms underlying craniofacial and corneal neuropathic pain and critically evaluates emerging regenerative therapies, including autologous biologics (autologous serum tears and platelet-rich plasma), mesenchymal stem cells and their derivatives, exosomes and extracellular vesicles, and neurotrophic peptides. Particular emphasis is placed on corneal neuropathic pain as a translational model, given the cornea’s dense sensory innervation and the ability to non-invasively quantify nerve regeneration using in vivo confocal microscopy as an objective biomarker of treatment response. Clinical evidence across regenerative modalities varies by indication: cenegermin has demonstrated robust efficacy and regulatory approval for neurotrophic keratitis, while platelet-rich plasma shows growing evidence in temporomandibular disorders, myofascial pain, and occipital neuralgia. Cell-based and cell-free therapies demonstrate strong preclinical promise but remain limited by heterogeneous protocols and a paucity of large-scale randomized trials. Key barriers to translation include regulatory uncertainty, lack of standardized outcome measures, and workforce and implementation challenges. Advancing regenerative therapies for craniofacial and corneal neuropathic pain will require rigorous clinical trials, biomarker-driven patient selection, and multidisciplinary collaboration. Sex as a biological variable remains underexplored across all regenerative modalities and represents a priority for future research.

Background: Postoperative pain management after cardiac surgery involves a multimodal approach. Recently, the erector spinae plane (ESP) block has been incorporated into multimodal pain control protocols. These measures have been taken to increase patient satisfaction while minimizing opioid usage. Prospective data is lacking to guide decisions regarding optimal regional anesthetic agents. This randomized controlled pragmatic trial protocol seeks to determine the benefit of liposomal bupivacaine relative to plain bupivacaine hydrochloride at reducing postoperative opioid consumption and other clinical outcomes following cardiac surgery. Methods: The investigators anticipate consenting 150 subjects to obtain 96 evaluable subjects undergoing minithoracotomy ( N = 24 liposomal bupivacaine, N = 24 bupivacaine hydrochloride) or open sternotomy ( N = 24 liposomal bupivacaine, N = 24 bupivacaine hydrochloride). The primary outcome will be postoperative opioid consumption, reported in morphine equivalents. Secondary outcomes will include postoperative nonopioid analgesic consumption, inpatient and outpatient postoperative pain scores, 30-day mortality and major morbidity rates, postoperative quality of life, and hospitalization costs. Double blinding will be conducted with necessary measures taken to mask electronic medical records and drug preparation. Discussion: The trial is currently enrolling subjects at a single academic medical center in the northeastern United States. The current study aims to investigate the postoperative pain reported by patients undergoing cardiac surgery when receiving ESP blocks with liposomal bupivacaine (experimental) compared to its hydrochloride formulation (control). Trial registration: ClinicalTrials.gov NCT06077422. Registered on October 2023. https://clinicaltrials.gov/study/NCT06077422?tab=table .

Background Postoperative pain management after cardiac surgery involves a multimodal approach. Recently, the erector spinae plane block (ESPB) has been incorporated into multimodal pain control protocols. These measures have been taken to increase patient satisfaction while minimizing opioid usage. Prospective data is lacking to guide decisions regarding optimal regional anaesthetic agents. The current randomized controlled pragmatic trial protocol seeks to determine the benefit of liposomal bupivacaine relative to plain bupivacaine hydrochloride at reducing postoperative opioid consumption and other clinical outcomes following cardiac surgery. Methods The investigators anticipate consenting 150 subjects to obtain 96 evaluable subjects undergoing mini thoracotomy (N = 24 liposomal bupivacaine, N = 24 bupivacaine hydrochloride) or open sternotomy (N = 24 liposomal bupivacaine, N = 24 bupivacaine hydrochloride). The primary outcome will be postoperative opioid consumption, reported in morphine equivalents. Secondary outcomes will include postoperative nonopioid analgesic consumption, inpatient and outpatient postoperative pains core, 30-day mortality and major morbidity rates, postoperative quality of life, and hospitalization cost. Double blinding will be conducted with necessary measures taken to mask electronic medical records and drug preparation. Discussion The trial is currently enrolling subjects at a single academic medical center in the northeastern United States. The current study aims to investigate the postoperative pain reported by patients undergoing cardiac surgery when receiving Erector Spinae Plane (ESP) block with liposomal bupivacaine (experimental) compared to its hydrocholoride formulation (control). Trial registration: Registered on ClinicalTrails.gov: NCT06077422. https://clinicaltrials.gov/study/NCT06077422?tab=table

Background and Aim of the Study. To investigate if mitral valve (MV) surgery quality differs by hospital volume in New Jersey (NJ). Methods. Using the NJ State Inpatient Database, patients 18years undergoing MV repair or replacement from 20162019 were identified. Centers were considered high-volume if they performed more than 50 mitral operations annually. Baseline characteristics and outcomes (in-hospital mortality, seven-day readmission, hospital length of stay (LOS), and postoperative complications) were evaluated for the population and by center volume. Subanalysis by center volume within each procedure was conducted. Results. Among 2,560 mitral operations, MV replacement (92.3 (n=2,362)) was performed more often than repair. High- (4) and low-volume (15) centers performed 1,180 (46.1) and 1,380 (53.9) mitral surgeries, respectively. Charlson Comorbidity Indices did not differ by center volume, including in subgroup analyses. Low-volume centers had higher rates of Hispanic patients, low-income patients, and readmission rates. High-volume centers had more transfers, urgent/emergent admissions, higher rates of in-hospital mortality, and longer LOS. Postoperative complications did not differ by volume. The MV replacement cohort reflected many of the differences seen in the total population, in addition to seeing higher rates of heart failure at high-volume centers and stroke at low-volume centers. Within MV repairs, significantly more Hispanic patients presented to low-volume centers and high-volume centers had longer LOS. Multivariable analysis indicated that hospital volume was not correlated to in-hospital mortality for the total population and within each procedure. Conclusions. MV replacement is performed more frequently than repair. Hospital volume is not correlated with MV surgical quality, and more representative quality measures are needed.

Point-of-care testing provides a representation of the patient’s coagulability status during effective postpartum hemorrhage management. Baseline values of rotational thromboelastometry (ROTEM) have not yet been reported in a heterogeneous obstetric population. This study aimed to establish a baseline for a diverse population representative of the United States. The secondary aim was to evaluate the association of these hematologic parameters with comorbidities, race, and socioeconomic factors. The study was a retrospective review of collected ROTEM values of women undergoing vaginal or cesarean delivery with a history of or at risk for postpartum hemorrhage. Patients were divided into healthy and comorbid groups. Exclusion criteria for both groups included active or recent bleeding, receipt of blood products or clot-enhancing factors, and liver disease. Mean values of ROTEM by race and comorbidities were included. Median values were reported for intrinsic pathway thromboelastometry (INTEM), extrinsic pathway thromboelastometry (EXTEM), and fibrin polymerization thromboelastometry (FIBTEM) amplitude at 10 minutes (A10) and 20 minutes (A20), coagulation time, clot formation time, and maximum clot firmness. A total of 681 records were reviewed; 485 met inclusion criteria, and 267 met healthy criteria. The mean (standard deviation) demographics for maternal age (years), body mass index (kg/m²), and gestational age (weeks) were 32.2 (5.7), 34 (7.3), and 35.4 (5), respectively. The median INTEM, EXTEM, and FIBTEM A10 were 63, 65, and 23 mm. The mean for INTEM, EXTEM, and FIBTEM A10 was increased for those who were Black or obese, whereas a decreased FIBTEM and EXTEM A10 was noted in those who were Asian or those who had the hemolysis, elevated liver enzymes, low platelet syndrome. Our heterogeneous population presents ROTEM values within the interquartile range of those previously reported in European studies. Black race, obesity, and preeclampsia were associated with hypercoagulable profiles.