BIOBEHAVIORAL PREDICTORS OF POSTOP PAIN & IMMUNE STATUS

术后疼痛的生物行为预测因子

• 批准号: 2038425
• 负责人: JOEL KATZ
• 金额: $ 13.21万
• 依托单位: TORONTO GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-07-01 至 2000-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2038425
• 关键词: blood pressure; catecholamines; clinical research; clinical trials; combination chemotherapy; cortisol; drug administration rate /duration; epidural anesthesia; fentanyl; heart rate; human subject; human therapy evaluation; hysterectomy; immunity; lidocaine; pain; postoperative state; psychological stressor

DESCRIPTION: Most patients who undergo major surgery do not receive adequate treatment of their pain. They suffer needlessly because traditional approaches to the management of acute post-operative pain have focused primarily on treating the patient after surgery in an effort to reduce already established pain. It is becoming increasingly clear, however, that the very act of cutting tissue, nerve, and bone may induce long-lasting changes in central neural function that amplify post-operative pain intensity, increase the need for analgesics, and set the stage for the development of chronic, intractable pain. One of the most effective ways to prevent noxious input during surgery from reaching the spinal cord is to administer local anesthetics and opioids via the epidural route before surgery. This preventive approach to the problem of acute post-operative pain has been termed pre-emptive analgesia and its significance lies not only in the obvious immediate benefit of protecting the patient at the time of surgical trauma, but also in the possibility that such pre-treatment will attenuate the development of central sensitization and of potentially detrimental changes in immune function. The proposed study uses a three group, randomized, double-blind, placebo-controlled, cross-over design. Patients undergoing abdominal hysterectomy will receive (1) pre-incisional epidural fentanyl and lidocaine followed by post-incisional epidural saline, (2) pre-incisional epidural saline followed by post-incisional fentanyl and lidocaine, or (3) pre and post-incisional saline via a sham epidural. All patients will receive a general anesthetic. It is hypothesized that, by interrupting the transmission of noxious peri-operative inputs to the spinal cord, the pre-emptive approach will attenuate the development of central sensitization and result in reduced pain and lower requirements for morphine long after the effects of the epidural agents have worn off. This project will also examine physiological mechanisms and psychosocial moderating factors involved in pain and immune function. Finally, the study will assess the effects of pre-operative psychosocial factors on changes in immune function, pain, and post operative adjustment. The broad aim of this intervention is to increase quality of life by decreasing stress, pain, analgesic requirements, and post-operative immune suppression, possibly reducing post-surgical complications due to infections and morphine usage. The anticipated morphine-sparing effect may reduce potential adverse effects, decrease treatment costs, and shorten length of hospital stay.

描述：大多数接受大手术的患者不会收到 他们的痛苦得到了适当的治疗。他们遭受不必要的痛苦是因为 处理手术后急性疼痛的传统方法有 主要专注于手术后患者的治疗，努力 减少已经存在的痛苦。这一点变得越来越清楚， 然而，切割组织、神经和骨骼的行为可能会导致 中枢神经功能的长期变化对术后的影响 疼痛强度，增加对止痛药的需求，并为 出现慢性、顽固性疼痛。最有效的方法之一就是 防止手术中有害物质进入脊髓是为了 经硬膜外途径给予局麻药和阿片类药物 做手术。这种预防性的方法来解决手术后的急性问题 疼痛被称为超前止痛，其意义并不在于 只有在当时保护病人的明显直接利益的情况下 手术创伤的可能性，但这种预治疗也有可能 减弱中枢敏感化的发展和潜在的 免疫功能的有害变化。 建议的研究采用三组随机、双盲、 安慰剂对照的交叉设计。接受腹部手术的患者 子宫切除术将接受(1)术前硬膜外芬太尼和利多卡因 然后是切开后硬膜外盐水，(2)切开前硬膜外 生理盐水，然后是术后芬太尼和利多卡因，或(3)麻醉前和 切开后通过假硬膜外注射生理盐水。所有患者都将收到 全身麻醉剂。据推测，通过中断 围手术期伤害性信息向脊髓的传递 先发制人的方法将削弱中枢敏感化的发展 并导致疼痛减轻，对吗啡的需求更低 硬膜外麻醉剂的作用已经消失了。该项目还将 考察生理机制和心理社会调节因素 与疼痛和免疫功能有关。最后，研究将评估 术前心理社会因素对免疫功能变化的影响 疼痛和术后调整。这次干预的广泛目的是 通过减少压力、疼痛和止痛剂来提高生活质量 要求，以及术后免疫抑制，可能会减少 手术后因感染和吗啡使用引起的并发症。这个 预期的吗啡戒断效应可能会减少潜在的不良影响， 降低治疗成本，缩短住院时间。