Perioperative Measures of Nociception using NIRS

摘要 手术是一个常见的过程--在美国，每年约有4300万人接受手术 年。根据发病前和术中过程的不同，个体容易患上急性胰腺炎 术后疼痛，更重要的是，约30%的慢性神经病理性疼痛导致 严重的发病率。虽然全身麻醉提供了一种无意识状态，但没有客观的 麻醉状态下诱发或持续疼痛的量度(即止痛)。缺乏止痛药控制 在麻醉状态下可能会在大脑中诱导一种称为中枢敏化的反应，这是 两种主要的有害后果：(1)术后疼痛增加和阿片类药物的使用；(2) 启动慢性神经病理性疼痛过程(这也可能是由手术造成的神经损伤引起的 伤口--外周敏化)。在这项提案中，我们将引入一种新的机械方法来 评估围手术期的伤害性驱动力(包括诱发性疼痛和持续性疼痛) 手术和术后期间)。我们将使用功能近红外光谱(FNIRS)来定义 诱发性疼痛和持续性疼痛(即，对手术中的止痛进行客观、定量的评估 环境)。这一组合将使我们能够在手术中测量伤害性负荷。我们假设 疼痛负荷与术后疼痛程度之间存在相关性 水平、术后止痛药使用情况。为了做到这一点，我们有两个具体目标：(1)fNIRS测量 阿片类药物阻断麻醉下疼痛负荷上的伤害性信号；以及(2)确定fNIR在 接受手术的患者围手术期(手术和术后)的疼痛负荷(诱发性和持续性疼痛) 膝关节镜术：单纯吸入麻醉组与吸入麻醉组+区域封闭组。我们 拥有合作多年的必要团队(NIRS物理学家、神经生物学家、Pain 专家、麻醉师和心理学家)、设备、出版物、初步数据和医院支助 成功地开展拟议的工作。这项研究的成功完成将为 未来的研究可能提供：(1)手术中止痛深度和疼痛负荷的客观测量 利用fNIRS；(2)持续和重复的有害事件对疼痛负荷和临床的相对意义 结果(2)客观测定不同麻醉药对疼痛负荷的影响。

ABSTRACT Surgery is a common process – with some 43 million individuals undergoing surgery in the United States every year. Depending on their premorbid and intraoperative processes, Individuals are vulnerable to acute postoperative pain and more importantly in some 30% to chronic neuropathic pain that contributes to significant morbidity. While general anesthesia provides a state of unconsciousness, there are no objective measures of evoked or ongoing pain (i.e., analgesia) while under anesthesia. The lack of analgesic control while under anesthesia may induce a response in the brain called central sensitization that is the harbinger of two main deleterious outcomes: (1) increased pain and use of opioids in the postoperative period, and (2) the initiation of a chronic neuropathic pain process (that may also be driven by the nerve damage from the surgical incisions – peripheral sensitization). In this proposal we will introduce a novel mechanistic approach to the assessment of nociceptive drive (both evoked pain and ongoing pain) in the perioperative period (i.e., during surgery and in the postoperative period). We will use functional Near-Infrared Spectroscopy (fNIRS) to define evoked pain and ongoing pain (i.e., an objective, quantitative assessment of analgesia in a surgical environment). The combination will allow us to measure the Nociceptive Load during surgery. We hypothesize that there is a correlation of the pain load and the postoperative course as measured by postoperative pain levels, postoperative analgesic use. In order to do this we have 2 Specific Aims: (1) fNIRS Measures of Opioid Blockade of Nociceptive Signals on Pain Load under Anesthesia; and (2) Define fNIRS Differences in Pain Load (Evoked and Ongoing Pain) in the Perioperative (surgery and post surgery) in patients undergoing knee arthroscopy who have inhalational anesthesia alone vs. inhalational anesthesia + regional blockade. We have the necessary team that has worked together for many years (NIRS physicists, neurobiologists, pain specialists, anesthesiologists and psychologist), equipment, publications, preliminary data and hospital support to successfully carry out the proposed work. The successful completion of this research will provide a basis for future studies that may provide: (1) Objective Measurement of Analgesic Depth and Pain Load during surgery utilizing fNIRS; (2) Relative significance of continuous and repeated noxious events on pain load and clinical outcomes (2) Objective Measurement of different anesthetics on Pain Load.