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原因。 依赖目前，美国市场上还没有产品可以用于监控 外科伤害感受现有产品使用易受术中影响的指示物，例如 失血、麻醉药和抗高血压药。这让麻醉师猜测是否 他们提供的镇痛治疗将有效地管理术中伤害感受和随后的疼痛。 术后疼痛。很大一部分手术也依赖于局部麻醉技术， 这些技术并不是万无一失的，在手术过程中可能会失败，导致潜在的无法控制的术后疼痛。 只有当病人在手术后的剧痛中恢复意识时，这一点才明显。就目前情况而言， 麻醉师无法直接评估其区域阻滞的持续有效性， 不可靠的伤害感受和疼痛管理。因此，监测手术伤害感受的改进方法是 显然需要。该项目提出开发新技术，使首次使用 事件相关电位（ERP），以积极评估全身麻醉和局部麻醉期间的疼痛和镇痛。 ERPs是由疼痛刺激产生的，可以通过对重复刺激的波形进行平均来在头皮上测量。 通过包括电刺激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至10微伏之间， 被振幅大10到100倍的背景脑电图振荡所掩盖 在全身麻醉或镇静期间。最近，我们开发了一种处理ERPs的新技术， 即使在存在数量级更大的背景振荡的情况下，也将其精度提高约150倍。 利用这些知识，我们建议开发这种技术用于商业用途的“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.