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A single intraoperative dose of vocacapsaicin successfully reduces postsurgical pain and opioid requirements for up to 96 hours after bunionectomy, with benefits extending for at least 2 weeks.
What if the most effective pain relief after surgery is delivered before the patient even leaves the operating room? New evidence suggests that a single local administration of vocacapsaicin, an investigational prodrug of the transient receptor potential vanilloid subfamily member 1 (TRPV1) agonist capsaicin, may provide prolonged postoperative analgesia while substantially reducing the need for opioid medications.
These findings come from a triple-blinded, randomized controlled trial involving 147 patients undergoing bunionectomy, a widely accepted model for evaluating acute postsurgical pain. Subjects were randomized in a 1:1:1:1 ratio to get a 14-mL surgical-site injection of placebo or vocacapsaicin at concentrations of 0.05 mg/mL, 0.15 mg/mL, or 0.30 mg/mL during surgery.
The study's key outcome assessed the area under the curve (AUC) of numerical rating scale (NRS) pain scores at rest through 96 hours in those receiving the highest vocacapsaicin dose (0.30 mg/mL). Prespecified secondary outcomes were the proportion of patients who remained opioid-free during the first 96 hours, total opioid consumption over the same period, and pain scores during the first week after surgery.
Those treated with vocacapsaicin 0.30 mg/mL experienced a 33% decrease in pain at rest during the first 96 hours vs. placebo (Cohen's d = 0.61). The analgesic effect extended beyond the immediate recovery period, with pain during the first postoperative week reduced by 37% (Cohen's d = 0.62). Remarkably, the treatment benefit continued for at least 2 weeks after surgery. The opioid-sparing effect was equally notable.
More than 1 in 4 patients (26%) who received the highest vocacapsaicin dose recovered without requiring any postoperative opioids, compared with 5% of patients receiving placebo (P = 0.025). Among those who did use opioids, total opioid consumption during the first 96 postoperative hours was reduced by 50% vs. placebo (Cohen's d = 0.76).
Researchers also identified a clear dose-response relationship, with increasing vocacapsaicin concentrations producing progressively better improvements across all efficacy outcomes. Vocacapsaicin illustrated a favorable safety profile, with no significant differences in any safety parameter compared with placebo.
As healthcare systems continue to prioritize opioid-sparing perioperative care, these outcomes position vocacapsaicin as a valuable investigational therapy capable of delivering durable pain control through a single intraoperative administration. If confirmed in larger clinical studies, this approach could reshape postoperative pain management by minimizing opioid exposure without sacrificing analgesic potency.
Anesthesiology
Safety and Efficacy of Vocacapsaicin for Management of Postsurgical Pain: A Randomized Clinical Trial
Steven L Shafer et al.
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