Nonpharmacologic Analgesia for Invasive Procedures

用于控制微创外科手术引起的痛苦的镇痛药和镇静剂效果有限，而且有严重的副作用。持续的痛苦不仅会干扰正在进行的手术的顺利进行，而且会在患者需要额外干预时引起不良反应。本研究的长期目标是提供一种安全实用的行为方法，以减少与侵入性手术相关的认知和生理困扰。一般来说，这些手术的窘迫处理依赖于麻醉剂和镇静剂的“静脉清醒镇静”。将静脉清醒镇静的风险与手术次数相结合，我们预测每年有47,000名患者出现严重的心肺并发症，2600人死亡。我们建议在手术期间和之后使用非药物镇痛来安全管理认知和生理上的痛苦。非药物镇痛包括放松训练、自我催眠和想象。在目前的资金支持下，我们能够证明在血管和肾脏干预期间给予患者自我催眠放松可以显著减少生理和认知困扰。随着催眠和对照治疗之间的差异在治疗过程中呈线性增长，问题出现了，这些影响是否同样延伸到恢复期及以后；以及那些经历了更长时间、更痛苦的手术（比如肿瘤栓塞）的患者是否会从中受益。具体目的是：1)前瞻性确定自我催眠放松对肿瘤栓塞过程中认知和生理应激的影响；2)前瞻性确定自我催眠放松对术后认知和生理应激的影响；3)确定术中自我催眠放松对后续肿瘤栓塞过程中应激的影响。我们假设自我催眠放松可以减少(1)肿瘤栓塞期间的认知和生理困扰，(2)肿瘤栓塞后缺血发作时的认知和生理困扰，以及(3)患者再次肿瘤栓塞时的认知和生理困扰。完成后，将通过对390例患者进行严格和实际的评估来了解非药物镇痛的疗效和持久性。自我催眠放松的相对表现将被量化，与标准护理和移情控制在一个特征良好的患者群体中进行比较。结果将为未来的研究设计提供所需的下一层次的数据，以确定多中心随机对照试验的广泛临床应用。

Analgesics and sedatives administered to control distress from minimally invasive surgical procedures have limited effectiveness and serious side effects. Unabated distress not only interferes with smooth progression of the ongoing procedure, but can elicit adverse responses when patients need additional intervention. The long-term objective of this research is to provide a safe and practical behavioral method for reducing cognitive and physiologic distress associated with invasive procedures. Distress management for these procedures, in general, relies on "intravenous conscious sedation" with narcotics and sedatives. Extrapolating the risk of intravenous conscious sedation to the number of procedures, we predict annually 47,000 patients to suffer serious cardiorespiratory complications and 2,600 deaths. We propose nonpharmacologic analgesia for safe management of cognitive and physiologic distress during and after procedures. Nonpharmacologic analgesia includes relaxation training, self-hypnosis, and imagery. With the current funding, we were able to show that self-hypnotic relaxation offered to patients during vascular and renal interventions significantly reduced physiologic and cognitive distress. As the differences between hypnosis and control treatments grew linearly over the procedure time, questions arose as to whether these effects extend similarly into the recovery period and beyond; and whether patients with lengthier and more painful procedures, such as tumor embolizations, would benefit. The specific aims are: 1) Prospectively determine the impact of self-hypnotic relaxation on cognitive and physiologic distress during tumor embolizations 2) Prospectively determine the impact of self-hypnotic relaxation on cognitive and physiologic distress in the postoperative period, and 3) Determine the impact of intraprocedural self- hypnotic relaxation on distress during subsequent tumor embolization. We hypothesize that self-hypnotic relaxation decreases cognitive and physiologic distress (1) during tumor embolizations, (2) after tumor embolization when post- embolization ischemia sets, and (3) when patients return for repeat tumor embolizations. On completion, the efficacy and durability administration of nonpharmacologic analgesia will be known by a rigorous and practical assessment of 390 patients. The relative performance of self-hypnotic relaxation will be quantified compared to standard care and empathic controls in a well- characterized population of patients. Results will provide the next level of data needed for future study design to determine broad clinical utility in a multicenter randomized controlled trial.