Perioperative Measures of Nociception using NIRS

使用 NIRS 进行围手术期伤害感受测量

• 批准号: 9388456
• 负责人: DAVID BORSOOK
• 金额: $ 36.81万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9388456
• 关键词: Ablation; Absence of pain sensation; Acute; Adult; Affect; Analgesics; Anesthesia procedures; Anesthetics; Arthroscopy; Auditory; Awareness; Biological Markers; Blood Pressure; Brain; Cardiac; Cardiac ablation; Clinical; Conduction Anesthesia; Consumption; Data; Dementia; Development; Dose; Environment; Equipment; Event; Future; General Anesthesia; Heart Rate; Hospitals; Individual; Inflammation; Intervention; Knee; Magnetic Resonance Imaging; Measurement; Measures; Methods; Morbidity - disease rate; Morphine; Near-Infrared Spectroscopy; Nerve; Neuraxis; Nociception; Nociceptors; Normal saline; Operating Rooms; Operative Surgical Procedures; Opioid; Opioid Analgesics; Outcome; Pain; Paralysed; Parietal Lobe; Patients; Perioperative; Peripheral; Pharmaceutical Preparations; Placebos; Postoperative Pain; Postoperative Period; Prefrontal Cortex; Prevalence; Prevention; Procedures; Process; Psychologist; Public Health; Publications; Reporting; Reproducibility; Research; Sedation procedure; Signal Transduction; Somatosensory Cortex; Specialist; Stimulus; Stroke; Surgical incisions; System; Unconscious State; United States; Work; attenuation; awake; central sensitization; chronic neuropathic pain; chronic pain; frontal lobe; innovation; insight; novel; opioid use; pain inhibition; painful neuropathy; remifentanil; response

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.

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。 年根据其发病前和术中过程，个体易受急性 术后疼痛，更重要的是约30%的慢性神经性疼痛， 严重的发病率。虽然全身麻醉提供了一种无意识的状态，但没有客观的 诱发或持续疼痛的测量（即，镇痛）。缺乏镇痛控制 而在麻醉状态下，可能会在大脑中引起一种称为中枢敏感化的反应， 两种主要的有害结果：（1）术后疼痛增加和阿片类药物的使用，以及（2） 慢性神经性疼痛过程的开始（其也可以由来自手术的神经损伤驱动）。 切口-外周致敏）。在这个建议中，我们将介绍一种新的机械方法， 在围手术期评估伤害性驱动（诱发的疼痛和持续的疼痛）（即，期间 手术和术后期间）。我们将使用功能近红外光谱（fNIRS）来定义 诱发的疼痛和持续的疼痛（即，一个客观的，定量的评估镇痛手术 环境）。结合起来我们就可以在手术中测量伤害性负荷。我们假设 疼痛负荷与术后病程（通过术后疼痛测量）之间存在相关性 水平，术后镇痛剂的使用。为了做到这一点，我们有2个具体目标：（1）fNIRS测量 麻醉下疼痛负荷时伤害性信号的阿片样物质阻断;和（2）定义fNIRS差异， 接受手术的患者围手术期（手术和术后）的疼痛负荷（诱发和持续疼痛） 单用吸入麻醉与吸入麻醉+区域阻滞的膝关节镜检查。我们 我有必要的团队，已经合作多年（近红外物理学家，神经生物学家，疼痛 专家、麻醉师和心理学家）、设备、出版物、初步数据和医院支持 顺利开展拟议工作。这项研究的成功完成将为 未来的研究可能提供：（1）术中镇痛深度和疼痛负荷的客观测量 （2）连续性和重复性伤害性事件对疼痛负荷和临床症状的相对意义 结果（2）不同麻醉药对疼痛负荷的客观测定。