Impact of Preemptive Analgesia on Recovery From Surgery

超前镇痛对手术恢复的影响

• 批准号: 6351996
• 负责人: ALLAN GOTTSCHALK
• 金额: $ 35.9万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-30 至 2001-12-21
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6351996
• 关键词: adult human (21+); analgesia; clinical research; clinical trials; cost effectiveness; epidural anesthesia; general anesthesia; health care cost /financing; human subject; human therapy evaluation; morphine; nursing care; pain; postoperative state; preoperative state; prostate surgery

Pain, often severe and inadequately treated, accompanies the more than 23 million surgical procedures performed annually in the U,S. Almost 2/3 of patients cite postoperative pain as their major preoperative fear. Apart from the mounting evidence that pain interferes with physiologic functions such as breathing, blood pressure regulation, etc., the pain associated with surgery limits the ability of patients to care for themselves, can be prolonged, may lead to chronic pain syndromes, and could possibly influence a patient's decision to delay or postpone potentially lifesaving surgery. Recent evidence indicates that residual pain following major surgery is more common than first appreciated, and that this pain is associated with significant decreases in functionality and self-perception of health. Painful stimuli initiate a cascade of responses which sensitize the nervous system so that subsequent painful stimuli are perceived with greater intensity and even typically painless stimuli can elicit pain. Preemptive analgesia is an intervention designed to prevent the sensitization of the nervous system produced by painful stimuli by beginning the analgesic regimen before the onset of pain stimuli. There is a definitive body of laboratory evidence and a growing body of clinical evidence that preemptive analgesia can reduce pain and analgesic needs following surgery, and our recent research indicates that this benefit can be observed in humans long after discharge from the hospital in the form of increased activity and decreased residual pain. One of the most common and clinically effective preemptive analgesic regimens involves the use of an epidural catheter. Adequate doses of medications introduced into the epidural space before the start of surgery and continued into the postoperative period appear to limit sensitization of the nervous system despite adequate levels of general anesthesia. However, preemptive epidural analgesia requires additional physician and other resources before, during and after surgery, Consequently, such an intervention will be supported by individual practitioners and third-party payers only in the face of demonstrable efficacy. This application considers the short- and long-term costs and benefits of aggressive preemptive epidural analgesia in generally healthy adult patients undergoing a common major abdominal surgical procedure. Pain during hospitalization and after discharge, activity levels, nursing needs, and the return to normal function will be quantitatively and economically assessed. These results will quantify the role played by aggressive perioperative pain management, will further link reductions in perioperative pain and outcome, and by quantifying the impact of recovery from major surgery will permit more rational allocation of scarce healthcare resources to effective strategies for acute pain management.

在美国，每年有2300多万例外科手术伴随着疼痛，通常是严重的和没有得到充分治疗的。几乎三分之二的患者将术后疼痛作为他们术前的主要恐惧。除了越来越多的证据表明疼痛会干扰呼吸、血压调节等生理功能外，与手术相关的疼痛还会限制患者的自我照顾能力，可能会延长时间，可能会导致慢性疼痛综合征，并可能影响患者推迟或推迟可能挽救生命的手术的决定。最近的证据表明，大手术后的残余疼痛比最初意识到的更常见，这种疼痛与功能和自我健康意识的显著下降有关。疼痛刺激引发一系列反应，使神经系统变得敏感，从而使随后的疼痛刺激更强烈地被察觉，甚至典型的无痛刺激也会引起疼痛。超前镇痛是一种干预措施，旨在通过在疼痛刺激开始之前开始止痛方案来防止疼痛刺激引起的神经系统敏感化。有确凿的实验室证据和越来越多的临床证据表明，超前止痛可以减少手术后的疼痛和止痛药需求，我们最近的研究表明，在出院后很长一段时间内，人类都可以观察到这种好处，表现为活动增加和残余疼痛减少。最常见和临床有效的超前止痛方案之一涉及使用硬膜外导管。手术前进入硬膜外间隙并持续到术后的足够剂量的药物似乎限制了神经系统的敏感化，尽管全身麻醉水平足够。然而，超前硬膜外镇痛在手术前、术中和术后都需要额外的医生和其他资源，因此，只有在有明显疗效的情况下，这种干预才会得到个人从业者和第三方付款人的支持。这项应用考虑了在一般健康的成年患者中接受普通的腹部大手术的积极超前硬膜外止痛的短期和长期成本和好处。住院期间和出院后的疼痛、活动水平、护理需求以及恢复正常功能将进行定量和经济评估。这些结果将量化积极的围手术期疼痛管理所发挥的作用，将进一步将围手术期疼痛的减少和结果联系起来，并通过量化大手术恢复的影响，将允许将稀缺的医疗资源更合理地分配给急性疼痛管理的有效战略。