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NCT03555266

NSS-2 BRIDGE Device in Post-Operative Pain Management

Completed NA Results posted Last updated 1 November 2021
What this trial tests

NA trial testing NSS-2 Bridge in Acute Pain in 65 participants. Completed in 30 June 2021.

Timeline
23 October 2018
Primary endpoint
8 March 2020
30 June 2021

Quick facts

Lead sponsorJacques E. Chelly
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingtriple
Primary purposetreatment
Enrollment65
Start date23 October 2018
Primary completion8 March 2020
Estimated completion30 June 2021
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

Jacques E. Chelly

Who can join

18 and older, any sex, with Acute Pain or Surgery. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Opioid Consumption Primary · 24 hrs, 48 hrs, 72 hrs, 96 hrs, and 120 hrs post-operative

Investigate the efficacy of the NSS-2 BRIDGE device in reducing perioperative opioid consumption in opioid-naïve patients undergoing major abdominal surgery using the current SHY ERAS anesthesia protocol. This is reported in consumption of oral morphine mg equivalents (OME) at 24 hrs, 48 hrs, 72 hrs, 96 hrs, and 120 hrs post-operative.

24 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol24± 27
Sham NSS-2 BRIDGE and ERAS Protocol38± 35
48 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol24± 31
Sham NSS-2 BRIDGE and ERAS Protocol27± 23
72 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol13± 19
Sham NSS-2 BRIDGE and ERAS Protocol22± 26
96 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol17± 22
Sham NSS-2 BRIDGE and ERAS Protocol23± 27
120 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol18± 23
Sham NSS-2 BRIDGE and ERAS Protocol23± 27
Post-Operative Pain Secondary · 24 hrs, 48 hrs, 72 hrs, 96 hrs, and 120 hrs post-operative

Numerical Rating Scale (NRS) Pain scores on a scale from 0-10, with 0 being no pain, 5 being moderate pain and 10 being the worst imaginable pain. The lowest possible score is 0 and the highest possible score is 10. Higher scores represent a worse outcome.

24 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol4.0± 2.0
Sham NSS-2 BRIDGE and ERAS Protocol4.1± 2.2
48 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol3.0± 1.9
Sham NSS-2 BRIDGE and ERAS Protocol3.8± 2.3
72 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol2.8± 2.0
Sham NSS-2 BRIDGE and ERAS Protocol3.5± 2.5
96 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol2.9± 2.3
Sham NSS-2 BRIDGE and ERAS Protocol3.1± 2.4
120 Hours
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol2.8± 2.0
Sham NSS-2 BRIDGE and ERAS Protocol3.6± 3.0
Non-narcotic Analgesic Consumption Secondary · Day of surgery through post-operative day 5

Investigate the efficacy of the NSS-2 Bridge Device in reducing perioperative consumption of non-narcotic analgesics.

Acetaminophen
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol10840.4± 4259.29
Sham NSS-2 BRIDGE and ERAS Protocol10195.9± 4134.82
Gabapentin
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol1168.4± 762.34
Sham NSS-2 BRIDGE and ERAS Protocol994.1± 561.77
Ibuprofen
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol3022.2± 2136.46
Sham NSS-2 BRIDGE and ERAS Protocol2657.1± 1192.84
Ketamine IV
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol197.6± 66.57
Sham NSS-2 BRIDGE and ERAS Protocol202.5± 49.21
Ketorolac
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol66.3± 42.05
Sham NSS-2 BRIDGE and ERAS Protocol92.9± 44.34
Total Post-operative Nausea and Vomiting (PONV) Secondary · Day of surgery through post-operative day 5

Evaluate the feeling of post-operative nausea and/or vomiting during the immediate 5 day post-operative period. This will be measured on a 10-point nausea scale from 0 (no nausea) to 10 (the worst nausea imaginable). The patient reports this score on a daily basis from post-op day 1 to post-op day 5 and the five daily scores will be added to calculate a total post-operative nausea score. The lowest possible total score is 0 and the highest possible total score is 50. A higher total score represents a worse outcome.

GroupValue95% CI
NSS-2 Bridge and ERAS Protocol1.08± 1.70
Sham NSS-2 BRIDGE and ERAS Protocol1.52± 2.78
Length of Recovery Room Stay Secondary · Day of surgery through recovery room discharge, up to 300 minutes post-operative

Evaluate time to recovery room discharge from out of OR time.

GroupValue95% CI
NSS-2 Bridge and ERAS Protocol192.3± 48.1
Sham NSS-2 BRIDGE and ERAS Protocol207.1± 84.4
Time to Ambulation (Walking Greater Than 15 Feet) Secondary · Day of surgery through time of ambulation, up to 120 hrs post-operative

Evaluate length of time till ambulation from out of OR time.

GroupValue95% CI
NSS-2 Bridge and ERAS Protocol26± 22.60
Sham NSS-2 BRIDGE and ERAS Protocol24± 18.95
Time to First Bowel Movement Secondary · Day of surgery through time of first bowel movement, up to 150 hrs post-operative

Evaluate length of time till first bowel movement from out of OR time.

GroupValue95% CI
NSS-2 Bridge and ERAS Protocol79± 32.63
Sham NSS-2 BRIDGE and ERAS Protocol62± 36.08
Time to Oral Intake Secondary · Day of surgery through time of oral intake, up to 160 hrs post-operative

Evaluate length of time till oral intake from out of OR time. Time to oral intake is recorded as the first consumption of fluids, medication, or food by mouth. This is especially important for patients undergoing abdominal procedures as the time to oral intake can be delayed following such procedures.

GroupValue95% CI
NSS-2 Bridge and ERAS Protocol45± 41.76
Sham NSS-2 BRIDGE and ERAS Protocol35± 37.39
Length of Hospital Stay Secondary · Day of surgery through discharge, up to 360 hrs post-operative

Evaluate time to hospital discharge from out of OR time.

GroupValue95% CI
NSS-2 Bridge and ERAS Protocol144± 48.7
Sham NSS-2 BRIDGE and ERAS Protocol122± 67.5
Overall Patient Satisfaction Secondary · Day of Surgery through time of discharge, up to 360 hrs post-operative

Participants will be asked to assess their overall satisfaction with care upon discharge on a 10-point satisfaction scale of 0 (least satisfaction) to 10 (highest satisfaction). The lowest possible score is 0 and the highest possible score is 10. Higher scores represent a better outcome.

GroupValue95% CI
NSS-2 Bridge and ERAS Protocol9.36± 1.18
Sham NSS-2 BRIDGE and ERAS Protocol9.39± 0.99
Satisfaction With Pain Management Secondary · Day of surgery through time of discharge, up to 360 hrs post-operative

Participants will be asked to assess their satisfaction with pain management upon discharge on 10-point satisfaction scale of 0 (least satisfaction) to 10 (highest satisfaction). The lowest possible score is 0 and the highest possible score is 10. Higher scores represent a better outcome.

GroupValue95% CI
NSS-2 Bridge and ERAS Protocol9.45± 0.80
Sham NSS-2 BRIDGE and ERAS Protocol9± 1.13
Functional Recovery Secondary · Day of surgery through 90 days post-operative.

Functional recovery will be measured by the assessment of the participant's answers to the Functional Recovery Questionnaire 12-Item Short Form Health Survey (SF-12). The SF-12 Health Survey includes questions from the SF-36 Health Survey (Version 1). Two summary scores are reported from the SF-12 - a mental component score (MCS-12) and a physical component score (PCS-12). The United States population average PCS-12 and MCS-12 are both 50 points. The United States population average PCS-12 and MCS-12 are both 50 points. The United States population standard deviation is 10 points. So each 10 i

Physical Component Score
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol37.5± 8.28
Sham NSS-2 BRIDGE and ERAS Protocol39.9± 10.03
Mental Component Score
GroupValue95% CI
NSS-2 Bridge and ERAS Protocol55.2± 7.45
Sham NSS-2 BRIDGE and ERAS Protocol52.1± 8.25

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse event data was collected for the duration of the subject's participation in the study (90 days post-operative).. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

NSS-2 Bridge and ERAS Protocol
Serious: 4/26 (15%)
Deaths: 0/26
Sham NSS-2 BRIDGE and ERAS Protocol
Serious: 2/27 (7%)
Deaths: 0/27

Serious adverse events (3 terms)

ReactionSystemNSS-2 Bridge and ERAS Prot…Sham NSS-2 BRIDGE and ERAS…
Organ morbidityRespiratory, thoracic and mediastinal disorders
Bowel complicationsGastrointestinal disorders
Surgical complicationsSurgical and medical procedures
Other adverse events (1 terms — click to expand)

ReactionSystemNSS-2 Bridge and ERAS Prot…Sham NSS-2 BRIDGE and ERAS…
Device dislodgementProduct Issues

Most-reported serious reactions: Organ morbidity, Bowel complications, Surgical complications.

Data from ClinicalTrials.gov NCT03555266 adverse events section.

Sponsor's own description

The current opioid epidemic has led to a renewed interest in exploring non-pharmacological techniques to treat post-operative pain. An increasing number of patients are suffering from the adverse effects of opioid use following surgery, including post-operative nausea and vomiting, respiratory depression, immunosuppression, constipation, and most recently, addiction. Although the risk of opioid addiction following surgery is recognized, the percentage of patients becoming addicted to opioids following surgery is not well understood. Therefore, in order to combat this growing health crisis at the ground level, it is incumbent upon the medical community to explore alternative methods of pain control to treat the surgical population in order to reduce the incidence of post-operative opioid addiction. Percutaneous Nerve Field Stimulation (PNFS) is one of these recognized methods that ongoing research has shown to be effective as a complementary method of pain management. While PNFS is not a novel concept, clinical indications of auricular field stimulation have been limited in the past due to requirement of bulky, stationary and non-disposable stimulators and electrodes. These technological limitations made it difficult to establish the real clinical potential of auricular stimulation for the perioperative management of pain in surgical patients, despite the demonstration that auriculotherapy has been shown to relieve pain in the postoperative setting. The NSS-2 BRIDGE is a battery operated and disposable percutaneous auricular nerve field stimulator (Innovative Health Solutions, Versailles, IN, USA), that was recently cleared by the FDA and assigned a Class II Risk Designation. The indication for the NSS-2 BRIDGE is for the treatment of clinical symptoms related to opioid consumption and opioid withdrawal. These symptoms include abdominal pain, anxiety and post-operative nausea and vomiting; conditions which are also present following major oncologic abdominal surgery. The use of the NSS-2 BRIDGE device has been demonstrated to provide significant analgesia in patients with abdominal pain syndrome, and clinical trials are ongoing to assess the benefit of this approach for post-operative pain management. As compared to the present use of opioids for perioperative pain management, the use of a complementary, non-pharmacologic approach offers the advantage of analgesia without the associated side effects.

Publications & conference data

2 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Neuromodulation Strategies to Reduce Inflammation and Improve Lung Complications in COVID-19 Patients.
    Czura CJ, Bikson M, Charvet L, Chen JDZ, et al · · 2022 · cited 13× · PMID 35911909 · DOI 10.3389/fneur.2022.897124
  2. Reduction in postoperative opioid requirement associated with use of the NSS-2<sup>®</sup> Bridge device, a disposable auriculo-nerve field stimulator, and factors affecting the response in cancer patients undergoing abdominal surgical procedures.
    Chelly JE, Holtzman MP, Bartlett DL, Choudry HA, et al · · 2024 · PMID 40352824 · DOI 10.36266/jpmtc/119

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