DAVID BORSOOK (2017-09-01 to 2021-07-31) Perioperative Measures of Nociception using NIRS. Amount: $1164620
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.
手术是一个常见的过程吗？每年有大约4300万人在美国接受手术。根据患者的病前和术中过程，个体易患急性术后疼痛，更重要的是约30％的慢性神经性疼痛导致严重的发病率。虽然全身麻醉提供了无意识状态，但在麻醉期间没有客观的诱发或持续疼痛（即镇痛）的措施。在麻醉期间缺乏镇痛控制可能在大脑中引起称为中枢致敏的反应，这是两种主要有害结果的预兆：（1）术后期间疼痛和阿片类药物使用增加，以及（2）开始治疗慢性神经性疼痛过程（也可能是由手术切口的神经损伤引起的？外周致敏）。在这个提议中，我们将介绍一种新的机械方法来评估围手术期（即手术期间和术后期间）的伤害性驱动（诱发疼痛和持续疼痛）。我们将使用功能性近红外光谱（fNIRS）来定义诱发的疼痛和持续的疼痛（即，在手术环境中对镇痛的客观，定量评估）。该组合将允许我们在手术期间测量伤害性负荷。我们假设通过术后疼痛水平，术后镇痛使用来测量疼痛负荷与术后病程之间的相关性。为了做到这一点，我们有2个具体目标：（1）fNIRS麻醉下疼痛负荷的伤害性信号的阿片类药物阻断措施; （2）定义单独吸入麻醉与吸入麻醉+区域阻滞的膝关节镜检查患者围手术期（手术和手术后）疼痛负荷（诱发和持续疼痛）的fNIRS差异。我们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，以成功完成拟议的工作。该研究的成功完成将为未来的研究提供基础，可能提供：（1）使用fNIRS测量手术中镇痛深度和疼痛负荷; （2）连续和重复有害事件对疼痛负荷和临床结果的相对重要性（2）目的测量不同麻醉药对疼痛负荷的影响。
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