Anesthesia, Catastrophizing, Nociceptive Pain, Pain, Postoperative
Conditions
Keywords
Monitoring, Biomarker, Thoracoscopy
Brief summary
This study evaluates the correlation between NoL index response to standardized stimulus under general anesthesia and the post-operative pain, assessed by opioid consumption and numerical pain scores after video-assisted thoracoscopy (VATS).
Detailed description
The NoL index, a nociception monitor using a multiparametric approach, has shown an excellent sensitivity and specificity in detecting noxious stimuli under general anesthesia. This monitor is better than any other parameter in grading nociception under general anesthesia. More recently, it has recently been shown a strong correlation between NoL index response to nociceptive stimulus and the level of opioid analgesia during surgery. No study has evaluated that NoL could predict post-operative pain so far. It has not yet been proven that NoL was correlated with post-operative opioid consumption or with post-operative pain scores. Some phenotypic factors were previously shown to correlate with post-operative pain and opioid consumption, such as psychological factors and tests, or also assessment of some pre-operative nociceptive thresholds (NT). Pain catastrophizing was proven in several studies to correlate with acute post-operative pain. So far, no study compared each of these preoperative psychological factors or nociceptif thresholds to the NoL index response to intraoperative standardized pain stimulus in terms of correlation with post-operative opioid requirements and pain scores. Moreover, there is no study evaluating the pro-inflammatory protein profiles that might likely be correlated to inter-individual differences in NoL response after this standardized nociceptive stimulus under general anesthesia. This study will assess the level of correlation between NoL index response to standardized stimulus under general anesthesia and the post-operative pain, assessed by opioid consumption and numerical pain scores after video-assisted thoracoscopy (VATS). It also evaluates the correlation between NoL index response to standardized stimulus under general anesthesia and pre-operative phenotype and post-operative pain biomarkers.
Interventions
DEVICEStandardized tetanic stimulation
The intervention is not a drug, but it is standardized electrical stimulus applied with a muscle relaxation monitor on the forearm of the anesthetized patient. The NoL index is registered in response to this stimulus in an observational manner. Device: Device PMD200TM offering intraoperative NoL Index
DIAGNOSTIC_TESTCatastrophizing score
Pre-operative catastrophizing score is correlated with post-operative pain and opioid consumption
DIAGNOSTIC_TESTNociceptive threshold
Nociceptive threshold for pressure, heat and electrical stimulation are associated with post-operative pain and will be assessed preoperatively to see if there is correlation between them and the NOL index response to the nociceptive stimulus (see intervention 1)
BIOLOGICALBiomarkers
Some biomarkers of inflammation and endogenous opioids are associated with post-operative pain. Blood samples will be withdrawn at D0 before surgery starts, D1 (H24) and D2 (H48) after surgery to see if they correlate with NOL changes after the stimulus described in intervention 1 above
Sponsors
Ciusss de L'Est de l'Île de Montréal
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
Prospective Pilot study
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patient (Age 18 or older) * ASA status I, II or III * elective video assisted thoracoscopy under general anesthesia
Exclusion criteria
* history of coronary artery disease * serious cardiac arrhythmia (including atrial fibrillation), * history of substance abuse, * chronic use of psychotropic and/or opioid drugs, * use of drugs that act on the autonomic nervous system (including β-blockers), * history of psychiatric diseases, * allergy to any drug used in the study protocol, * refusal of the patient * unexpected difficult airway requesting excessive, possibly painful airway manipulations * unexpected intraoperative complications requiring strong hemodynamic support (transfusions, vasopressors, inotropes) * conversion to thoracotomy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between NoL index and Hydromorphone consumption H24 | Day 1 at 24 hours | Correlation between NoL index absolute values after electrical stimulus under general anesthesia and Total hydromorphone consumption (PACU and PCA) 24h after surgery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between NoL index and Pain scores (NRS from 0 to 10) in PACU | Day 0 at hour 2 | Correlation between NoL index absolute values after electrical stimulus under general anesthesia and Pain scores after surgery, in post anesthesiology care unit |
| Pain scores (NRS from 0 to 10) at H24 at rest | Day 1 at 24 hours | Pain scores (NRS from 0 to 10) at H24 at rest |
| Correlation between NoL index and Pain scores (NRS) from 0 to 10 at H24 at rest | Day 1 at 24 hours | Correlation between NoL index absolute values after electrical stimulus under general anesthesia and Pain scores (NRS) at H24 at rest |
| Pain scores (NRS) at H24 while coughing from 0 to 10 | Day 1 at 24 hours | Pain scores (NRS) at H24 while coughing from 0 to 10 |
| Correlation between NoL index and Pain scores (NRS) from 0 to 10 at H24 while coughing | Day 1 at 24 hours | Correlation between NoL index absolute values after electrical stimulus under general anesthesia and Pain scores (NRS) at H24 while coughing |
| Pain scores (NRS) at H48 at rest from 0 to 10 | Day 2 at 48 hours | Pain scores (NRS) at H48 at rest from 0 to 10 |
| Correlation between NoL index and Pain scores (NRS) from 0 to 10 at H48 at rest | Day 2 at 48 hours | Correlation between NoL index absolute values after electrical stimulus under general anesthesia and Pain scores (NRS) at H48 at rest |
| Pain scores (NRS) at H48 while coughing from 0 to 10 | Day 2 at 48 hours | Pain scores (NRS) at H48 while coughing from 0 to 10 |
| Correlation between NoL index and Pain scores (NRS) from 0 to 10 at H48 while coughing | Day 2 at 48 hours | Correlation between NoL index absolute values after electrical stimulus under general anesthesia and Pain scores (NRS) at H48 while coughing |
| total hydromorphone consumption (mg) in PACU | Day 0 at 2 hours | general anesthesia and total hydromorphone consumption (mg) in PACU |
| Correlation between NoL index and total hydromorphone consumption (mg) in PACU | Day 0 at 2 hours | Correlation between NoL index absolute values after electrical stimulus under general anesthesia and total hydromorphone consumption (mg) in PACU |
| Total hydromorphone consumption (mg) at H48 | Day 2 at 48 hours | Total hydromorphone consumption (mg) at H48 |
| Correlation between NoL index and total hydromorphone consumption (mg) at H48 | Day 2 at 48 hours | Correlation between NoL index absolute values after electrical stimulus under general anesthesia and total hydromorphone consumption (mg) at H48 |
| Pain scores (NRS) in PACU from 0 to 10 | Day 0 at hour 2 | Pain scores from 0 to 10 after surgery, using numerical rating scale in post anesthesiology care unit |
| Correlation between Pain catastrophizing scale from 0 to 50 and Total (hydromorphone consumption at day 1 24 hours) | Day 1 at 24 hours | Correlation between Pain catastrophizing scale and Total hydromorphone |
| Correlation between Pain catastrophizing scale from 0 to 50 and NoL index | Day 0 | Correlation between pre-operative Pain catastrophizing scale and NoL index absolute values after electrical stimulus under general anesthesia |
| State-Trait anxiety Inventory from 0 to 80 (fully validated and published questionnaire) | Day 0 | State-Trait anxiety Inventory from 0 to 80 |
| Correlation between State-Trait anxiety Inventory questionnaire from 0 to 80 and NoL index | Day 0 | Correlation between pre-operative State-Trait anxiety Inventory and NoL index absolute values after electrical stimulus under general anesthesia |
| Correlation between State-Trait anxiety Inventory from 0 to 80 and Total hydromorphone consumption at H24 | Day 1 24 hours | Correlation between State-Trait anxiety Inventory and Total hydromorphone consumption at H24 |
| mechanic pain threshold | Pre-operative, 2 hours prior to surgery | mechanic pain threshold using electronic Von Frey |
| thermal pain threshold | Pre-operative, 2 hours prior to surgery | thermal pain threshold using Qsense device |
| electrical pain threshold | Pre-operative, 2 hours prior to surgery | electrical pain threshold using Pain Matcher device |
| Biomarkers level Pre-op | Pre-operative, H0 right after induction of general anesthesia | Biomarkers level Pre-op |
| Biomarkers level H24 | Day 1 24 hours | Biomarkers level H24 |
| Biomarkers level H48 | Day 2 48 hours | Biomarkers level H48 |
| Brief Pain inventory (3M) Questionnaire (validated and published questionnaire) | 3 months | Brief Pain inventory (3M) |
| Pain catastrophizing scale from 0 to 50 (fully validated and published questionnaire) | Pre-operative, 2 hours prior to surgery | Pain catastrophizing scale from 0 to 50 |
Countries
Canada
Outcome results
None listed