Perioperative Measures of Nociception using NIRS

使用 NIRS 进行围手术期伤害感受测量

基本信息

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
项目类别：
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

项目摘要

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.

抽象的手术是一个常见的过程——在美国，每年约有 4300 万人接受手术根据其病前和术中过程，个人容易患急性疾病。术后疼痛，更重要的是，约 30% 是慢性神经性疼痛，这会导致虽然全身麻醉提供了一种无意识状态，但没有客观的发病率。麻醉下诱发或持续疼痛（即镇痛）的措施缺乏镇痛控制。而在麻醉状态下可能会引起大脑中一种称为中枢敏化的反应，这是两个主要的有害结果：（1）术后疼痛加剧和阿片类药物的使用，以及（2）慢性神经性疼痛过程的开始（也可能是由手术引起的神经损伤引起的）切口 - 外周敏化）。在本提案中，我们将引入一种新颖的机械方法。围手术期（即手术期间）伤害性驱动（诱发疼痛和持续疼痛）的评估手术中和术后期间）我们将使用功能性近红外光谱（fNIRS）来定义。诱发疼痛和持续疼痛（即对手术中的镇痛进行客观、定量的评估）该组合将使我们能够测量手术期间的伤害性负荷。通过术后疼痛测量，疼痛负荷与术后病程之间存在相关性为了做到这一点，我们有 2 个具体目标：(1) fNIRS 测量。阿片类药物阻断麻醉下疼痛负荷的伤害性信号；以及 (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（诱发性疼痛和持续性疼痛）单独吸入麻醉与吸入麻醉+区域封锁的膝关节镜检查。拥有多年合作的必要团队（NIRS 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为顺利完成本次研究工作奠定了基础。未来的研究可能会提供：（1）手术期间镇痛深度和疼痛负荷的客观测量 (2)连续和重复的伤害性事件对疼痛负荷和临床的相对意义结果 (2) 客观测量不同麻醉剂对疼痛负荷的影响。