Acute Pain, Chronic Pain, Inflammation, Inflammatory Response
Conditions
Brief summary
The inflammatory process is the main mechanism in the occurrence of acute postoperative pain. It is also the main risk for the development of acute pain into persistent pain. Inflammation occurs in the process of peripheral sensitization and central sensitization with various inflammatory mediators. Postoperatively, there will be proliferation and activation of microglia and astrocytes which will then activate inflammatory receptors and signaling cascades of neurotransmitters, cytokines, and chemokines. There has been a lot of clinical research evidence that multimodal analgesia can adequately treat acute pain and can prevent the development of acute postoperative pain into persistent pain and chronic postoperative pain, but the molecular mechanisms are not fully understood.
Interventions
DRUGMultimodal analgesia
Multimodal analgesia includes the combination of: 1. morphine given by PCA (patient-controlled analgesia) at 1 mg/dose 2. bupivacaine 0.25% and dexmedetomidine 0.5 mcg/mL (total volume of 10 mL) by epidural-catheter bolus given preoperatively 3. bupicavaine 0.125% and dexmedetomidine 0.5 mcg/mL at a 5 mL/hour rate per epidural-catheter given intraoperatively 4. bupivacaine 0.1% and dexmedetomidine 0.5 mcg/mL given by programmed intermittent epidural bolus (PIEB), set to be delivered every one-hour 5. etericoxib 90 mg per oral give two-hours before surgery and then continued until three days post-surgery 6. paracetamol 1 g (intravenously) given on the day of the surgery, continued at 10 mg/kg dose every 8 hours until three days post-surgery
Standard analgesia includes fentanyl 2 mcg/kg (bolus) and morphine given by PCA (patient-controlled analgesia) at 1 mg/dose
Sponsors
Udayana University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Scheduled for elective hysterectomy * American Society of Anesthesiologists (ASA) physical status 1 to 3
Exclusion criteria
* allergy to studied drugs * history of chronic pain * history of hepatitis, depression, peptic ulcer, or acute myocardial infarction * receive intraoperative massive blood transfusion * prolonged coagulation * body mass index \>35 kg/m2 * patients with neurological deficits * taking anti-platelet medications
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Preoperative MCP-1 | 1-hour before surgery | serum level of MCP-1 |
| Preoperative BDNF | 1-hour before surgery | serum level of BDNF |
| Preoperative MiRNA-124 | 1-hour before surgery | serum level of MiRNA-124 |
| Postoperative MCP-1 | 48-hours after surgery | serum level of MCP-1 |
| Postoperative BDNF | 48-hours after surgery | serum level of BDNF |
| Postoperative MiRNA-124 | 48-hours after surgery | serum level of MiRNA-124 |
Countries
Indonesia
Outcome results
None listed