权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Opioid-Sparing Effects of Nurse-Delivered Hypnosis During Breast Cancer Surgery

乳腺癌手术期间护士催眠的阿片类药物节省效果

基本信息

批准号：
10668632
负责人：
Lorenzo Cohen
金额：
$ 66.95万
依托单位：
UNIVERSITY OF TX MD ANDERSON CAN CTR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-05-01 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10668632
关键词：
Absence of pain sensation Address Affect Analgesics Anesthesia procedures Anxiety Breast Cancer Treatment Breast biopsy Cellular Immunity Certified registered nurse anesthetist Clinical Data Day Surgery Dose Europe Fatigue Fentanyl General Anesthesia Hypnosis Ileus Immunosuppression Impaired cognition Individual Differences Infusion procedures Intervention Intravenous Anesthesia Laryngeal Masks Light Local Anesthetics Local anesthesia Medical Medical Care Costs Methods Mission Nausea Neurologic Nurses Operative Surgical Procedures Opioid Pain Patient Outcomes Assessments Patient Self-Report Patients Pharmaceutical Preparations Physiological Population Postoperative Nausea and Vomiting Postoperative Period Procedures Process Propofol Pruritus Psychological Stress Psychosocial Factor Public Health Randomized Recovery Recovery Room Reporting Research Risk Schedule Sentinel Lymph Node Biopsy Serious Adverse Event Surgical complication Techniques Testing Thinking Time Time and Motion Studies Unconscious State United States United States National Institutes of Health Urinary Retention Vomiting Woman absorption biopsychosocial breast lumpectomy breast surgery cancer diagnosis cancer surgery cancer therapy clinical practice cost cost effective economic evaluation efficacy evaluation expectation hemodynamics improved improved outcome instrumentation intervention effect malignant breast neoplasm member men morphine equivalent opioid epidemic opioid misuse opioid sparing opioid use outcome prediction pain sensitivity postoperative recovery psychologic randomized trial response satisfaction side effect standard care standard of care time use trait treatment as usual tumor wound healing

项目摘要

PROJECT SUMMARY/ABSTRACT Breast cancer accounts for one in four cancer diagnoses in women, affecting up to one in eight women in the United States. All patients with breast cancer undergo surgery, yet surgery is not without risks and is associated with a multitude of side effects. Many of the complications from surgery are from the use of general anesthesia and intra- and postoperative opioids. Side effects of general anesthesia include hemodynamic instability, postoperative nausea and vomiting, suppression of cell-mediated immunity, cognitive impairment, and delayed recovery. The use of opioids is also associated with postoperative nausea and vomiting, ileus, urinary retention, pruritus, and immunosuppression. Frequently, intra- and postoperative opioid use often leads to an increased risk for non-medical opioid use and opioid-sparing techniques are needed. Extensive data supports the use of non-pharmacological interventions including hypnosedation (HS) for patients undergoing invasive medical procedures. In a variety of medical populations, patients using HS report significantly less anxiety and pain, demonstrate beneficial physiological responses, request less analgesic medication, and spend less time in the procedure room than controls. In a number of studies, the improved patient-reported outcomes and overall satisfaction was also paralleled by decreased medical costs. All of these previous studies either delivered the HS during simple medical procedures (e.g., breast biopsy) or before more invasive procedures such as breast surgery and no RCTs have provided hypnosis during surgery delivered by one of the surgical team members. The proposed trial will randomize women and men with breast cancer scheduled for a lumpectomy ± sentinel node biopsy to one of three groups: 1) surgery with a local anesthetic, fentanyl, and HS before and during surgery (HS); 2) HS before surgery with usual care general anesthesia (HS-GA; propofol infusion, fentanyl, and local anesthetic); or 3) Usual care general anesthesia (GA). The study will examine differences in opioid use, pain, anxiety, nausea, fatigue, and cognitive dysfunction before and after surgery. Recovery will be also tracked 14 and 90 days after surgery. The study will also examine group differences in medical costs associated with procedure time, recovery room time, and use of medications. This project will allow further exploration of HS during surgery provided by a clinical team member and to explore the biopsychosocial processes associated with analgesia and opioid use, anesthesia, and pain and examine baseline individual difference factors associated with the intervention effects and recovery. We specifically propose to test the hypothesis that HS during breast cancer surgery will result in better analgesia control along with lower opioid use, less pain and psychological stress, and faster recovery than GA. Data from the proposed study will help to move this intervention into the standard of care and expand the use of HS into other invasive medical procedures where general anesthesia may be avoided.

项目总结/文摘