Nonpharmacologic Analgesia for Invasive Procedures

使用镇痛剂和镇静剂来控制微创手术带来的痛苦，效果有限，副作用严重。持续的痛苦不仅干扰了正在进行的手术的顺利进行，而且当患者需要额外的干预时，还会引起不良反应。这项研究的长期目标是提供一种安全和实用的行为方法，以减少与侵入性操作相关的认知和生理痛苦。一般说来，这些程序的痛苦处理依赖于使用麻醉剂和镇静剂的“静脉清醒镇静”。将静脉清醒镇静的风险外推到手术次数，我们预测每年有47,000名患者遭受严重的心肺并发症，2,600人死亡。我们建议非药物止痛用于术中和术后认知和生理障碍的安全管理。非药物止痛包括放松训练、自我催眠和想象。有了目前的资金，我们能够证明在血管和肾脏干预期间为患者提供的自我催眠放松显著减少了生理和认知方面的痛苦。随着催眠和对照治疗之间的差异随着手术时间的推移呈线性增长，这些影响是否同样会延伸到恢复期和之后，以及接受更长时间和更痛苦的手术(如肿瘤栓塞术)的患者是否会受益的问题出现了。其具体目的是：1)前瞻性地确定自我催眠放松对肿瘤栓塞术中认知和生理痛苦的影响；2)前瞻性地确定自我催眠放松对术后认知和生理痛苦的影响；3)确定术中自我催眠放松对随后的肿瘤栓塞术中痛苦的影响。我们假设，自我催眠放松可以减少认知和生理痛苦(1)在肿瘤栓塞术期间，(2)当栓塞术后缺血时，以及(3)当患者再次进行肿瘤栓塞术时。完成后，通过对390名患者进行严格和实用的评估，将知道非药物止痛的有效性和持久性。自我催眠放松的相对表现将在一个具有良好特征的患者群体中与标准护理和同理心对照进行量化。结果将为未来的研究设计提供所需的下一级数据，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.