BIOBEHAVIORAL PREDICTORS OF POSTOP PAIN & IMMUNE STATUS

术后疼痛的生物行为预测因子

• 批准号: 2703101
• 负责人: JOEL KATZ
• 金额: $ 14.85万
• 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/2703101
• 关键词: behavioral /social science research tag; 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接受 充分治疗他们的痛苦。 他们遭受不必要的痛苦， 处理急性术后疼痛的传统方法 主要集中在治疗手术后的病人， 减轻已经形成的疼痛。 越来越清楚的是， 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， 疼痛强度，增加止痛药的需求，并为 慢性顽固性疼痛的发展。 最有效的方法之一， 在手术过程中防止有害输入到达脊髓是为了 通过硬膜外途径给予局部麻醉剂和阿片类药物， 手术 这种预防性的方法，以问题的急性手术后 疼痛被称为超前镇痛，其意义不在于 只是为了保护当时的病人 手术创伤，但也有可能，这种预处理将 减弱中枢致敏作用的发展， 免疫功能的有害变化。 本研究采用三组、随机、双盲、 安慰剂对照，交叉设计。 接受腹部手术的患者 子宫切除术将接受（1）切口前硬膜外芬太尼和利多卡因 切口后硬膜外注射生理盐水，（2）切口前硬膜外注射 生理盐水，然后是切口后芬太尼和利多卡因，或（3）术前和术后 切开后通过假硬膜外注射生理盐水 所有患者都将接受 全身麻醉 据推测，通过中断 将有害的围手术期输入传递到脊髓， 先发制人的方法将减弱中枢敏感化的发展 并导致疼痛减轻和对吗啡的需求降低， 硬膜外麻醉剂的效果已经消失了 该项目还将 检查生理机制和心理社会调节因素 参与疼痛和免疫功能。 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。 这次干预的主要目的是 通过减少压力、疼痛、止痛药 需求，以及术后免疫抑制，可能会减少 感染和吗啡使用导致的术后并发症 的 预期的吗啡节省效果可以减少潜在的副作用， 降低治疗费用，缩短住院时间。