Acute Postoperative Pain Clinical Trial
Official title:
Prediction of Postoperative Pain by Measuring Nociception at the End of Surgery
There is a large variability of postoperative pain intensity and of the drug doses necessary to alleviate this pain. The investigators hypothesis is that a measurement of nociception at the end of surgery, using either the RIII reflex threshold, measures of heart rate variability or the pupil dilatation reflex measured by pupillometry, in relation to the doses of opioids used intraoperatively will yield a prediction of postoperative pain.
Acute postoperative pain needs to be alleviated quickly to avoid sensitization in the
postoperative period, since sensitization can lead to pain chronification. Severe acute
postoperative pain is the most important risk factor in the development of persistent
postoperative pain.
Unfortunately, the dose of opioids necessary to alleviate postoperative pain is highly
variable, even between patients having been exposed to the same surgical procedure.
Anesthesiologists usually try to prevent immediate postoperative pain by adjusting analgesic
dosing at the end of surgery to the perceived need of analgesia. However, this approach is
limited by the problem of respiratory depression induced by a too large dose of opiate
analgesics. Studies have shown that despite these attempts many patients awake with moderate
to severe pain.
A means of predicting immediate postoperative pain after surgery and the response to opiate
analgesics would therefore be highly desirable. Many studies have tried to reveal predictive
factors which can be evaluated before the start of the surgery, but these can explain only
about 50% of the observed variability in postoperative pain intensity.
A different approach may be the evaluation of intraoperative nociception at the end of
surgery to directly guide appropriate analgesia before the patient has regained
consciousness. Measuring reflex pupil dilation after a standardized electrical stimulus is
one method to measure opioid effect intra-operatively. This parameter may reflect opioid
sensitivity, but not pain sensitivity.
The primary objective of this study is the evaluation of measures of nociception such as the
pupillary dilation reflex or heart rate variability on acute pain after surgery.
In addition, pupillary dilation reflex and heart rate variability will be evaluated in their
predictive performance of blood pressure and heart rate changes due to intubation.
The study is designed as a single centre, observational, descriptive study.
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