Developing Active Stimulation and Monitoring Technologies to Optimize Pain and Nociception Management During Regional Anesthesia, General Anesthesia, and Post-Operative Care

项目摘要 手术和术后急性疼痛是持续性疼痛、慢性疼痛和阿片类药物的主要诱因。 依赖。目前，美国市场上还没有可以用来监控的产品 外科伤害性感受。现有产品使用的指标容易受术中影响，例如 失血、麻醉药和降压药。这让麻醉师猜测是否会有 他们提供的止痛治疗将有效地管理术中伤害感和随后的 术后疼痛。很大一部分手术也依赖于区域麻醉技术，而且，这些 技术并不是万无一失的，在手术中可能会失败，导致潜在的无法控制的术后疼痛 只有当患者在手术后在剧烈的疼痛中恢复意识时，这一点才明显。在目前的情况下， 麻醉师无法直接评估其区域阻滞的持续疗效，导致 不可靠的伤害感和疼痛管理。因此，监测手术伤害感的改进方法是 显然是有必要的。该项目建议开发新技术，使其能够首次使用 事件相关电位(ERPs)以积极评估全身和区域麻醉期间的疼痛和止痛。 事件相关电位是由疼痛刺激产生的，可以在头皮通过对重复刺激的波形求平均来测量 由包括电刺激在内的各种方法产生的刺激。ERP即使不是不可能，也是具有挑战性的 用于麻醉监测，因为它们非常小，在~1到10微伏之间，并且 被幅度大10到100倍的背景脑电振荡所掩盖 在全身麻醉或镇静期间。最近，我们开发了一种处理事件相关电位的新技术 即使在存在数量级更大的背景振荡的情况下，它们的精度也提高了约150倍。 利用这一知识，我们建议将这项技术开发为商业用途，用于“快速通道”STTR项目。

Project Summary Surgery and acute post-operative pain are major contributors to persistent pain, chronic pain, and opioid dependence. Currently, there are no products on the market in the United States that can be used to monitor surgical nociception. Existing products use indicators that are susceptible to intraoperative influences such as blood loss, anesthetic drugs and antihypertensives. This leaves anesthesiologists to guess whether or not the analgesic therapies they are providing will be effective at managing intra-operative nociception and subsequent post-operative pain. A significant fraction of surgeries also rely on regional anesthesia techniques, and, these techniques are not foolproof, and may fail during surgery, leading to potentially uncontrolled postoperative pain that is apparent only when the patient recovers consciousness after surgery in intense pain. As it stands, anesthesiologists have no way to directly assess the ongoing efficacy of their regional blocks, leading to unreliable nociception and pain management. Therefore, improved methods to monitor surgical nociception are clearly needed. This project proposes to develop new technology that makes it possible for the first time to use event-related potentials (ERPs) to actively assess pain and analgesia during general and regional anesthesia. ERPs are generated by painful stimuli and can be measured at the scalp by averaging waveforms from repeated stimuli generated by a variety of methods including electrical stimulation. ERPs are challenging if not impossible to use for anesthesia monitoring because they are very small, between ~1 to 10 microvolts, and are overshadowed by background electroencephalogram oscillations that are 10- to 100-fold larger in amplitude during general anesthesia or sedation. Recently, we developed a novel technology for processing ERPs that increases their precision ~150-fold even in the presence of orders-of-magnitude larger background oscillations. Using this knowledge, we propose to develop this technology for commercial use in a “Fast-Track” STTR project.