Sngception and Pain in Spine Enhanced Recovery After Surgery (ERAS) Pathways

NCT05885802 | Unknown

• 1 other identifier: IRB 2022-09-009BC
• Study Type: observational
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

Enhanced recovery after surgery (ERAS) is a recognized, evidence-based and patient-centered clinical pathway that has an array of benefits. Minimally invasive techniques, a cyclopedic pain management plan and precise administration of anesthetics, which will render patients a rapid and comfortable recovery if executed correctly, followed by early mobilization and discharge. Pain management practice is traveling through a paradigm shift as opioid crises arise in the western countries. Opioid-based pain control is being disarmed and replaced by multimodal analgesia (MMA) and becoming the mainstay strategy. Opioids are increasingly being reserved as rescue medications. MMA target different parts of the nociceptive pathway, preventing its wind-up during surgery. Decreased firing of the nociceptive neurons may be linked to lower postoperative pain scores or even the suppressing chronic pain incidence. In our ERAS pathway, we implement erector spinae plane block (ESPB) as the main analgesic firepower. As postoperative pain decreases, an observed rising complaint is "sng", or soreness, in native Taiwanese in our ERAS spine patients. It is very different from the nociceptive "pain" we are familiar with. Patients avoid movements if it causes pain, but they tend to stretch or adjust postures if sngception dominates. The term "sngception" has been proposed in 2018 by Taiwanese scholars. It is believed to be a sense of acidosis, possibly within the muscles. Acidosis and associated pain are well documented, such as in muscle aches from exercise, cancer or diabetic ketoacidosis. The underlying mechanism is yet to be established but does not entirely overlap with nociception. There are numerous similarities of sngception in our patients and sngception:

1. 1.a sensation different from nociception,
2. 2.usual painkillers are ineffective, suggesting an alternative route of transmission,
3. 3.relieved by movement,
4. 4.inflammation and acidosis in the vicinity of surgical wound. In this study, we intended to characterize sngception by observing various perioperative factors, as well as the short- and long- term outcomes they bring. This will be done through a detailed sngception and pain trajectory analysis. Only when we know the main causative factor(s), we can design treatment plans toward guarding against sngception. This further improves the quality of postoperative recovery and safety as less opioids may be required as rescue medications.

Conditions

Pain Postoperative

Keywords

enhanced recovery; ERAS; Spine surgery; pain; sngception; sng

Outcome Measures

Primary Outcomes (2)

• Postoperative Sngception (Sng)

  Sng score evaluated by the numerical rating scale (NRS, score 0\~10).

  From enrollment to 1 year after surgery.

• Postoperative Pain

  Pain score evaluated by the numerical rating scale (NRS, score 0\~10).

  From enrollment to 1 year after surgery.

Secondary Outcomes (1)

• Morphine consumption

  From enrollment to discharge, an average of 5 days.

Study Arms (1)

ERAS group

Routine spine surgical patients receiving ERAS protocol that complies with current guidelines.

Other: No specific intervention other than routine anesthesia protocol

Interventions

No specific intervention other than routine anesthesia protocol OTHER

No specific intervention other than routine anesthesia protocol

ERAS group

Eligibility Criteria

• Age: 20 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients receiving routine ERAS management for spine surgeries. All patients will be screened for eligibility.

You may qualify if:

• Patients undergoing routine ERAS protocol for spine surgeries
• American Society of Anesthesiologists Physical Status (ASA-PS) I\~III

You may not qualify if:

• Communication issues that preclude proper preoperative counselling for ERAS and study design.
• Active alcohol or drug addiction.
• Pregnancy
• Allergy to main anesthetics that preclude the use of routine ERAS anesthesia management.
• Patient refusal to participate in study.
• Emergent operations.

Sponsors & Collaborators

• Taipei Veterans General Hospital, Taiwan: lead
• National Taiwan University Hospital: collaborator

Study Sites (1)

Taipei Veterans General Hospital

Taipei City, Taipei, 11217, Taiwan

RECRUITING

Related Publications (1)

• Lin JH, Hung CH, Han DS, Chen ST, Lee CH, Sun WZ, Chen CC. Sensing acidosis: nociception or sngception? J Biomed Sci. 2018 Nov 29;25(1):85. doi: 10.1186/s12929-018-0486-5.

  PMID: 30486810 BACKGROUND

MeSH Terms

Conditions

Pain, Postoperative; Pain

Condition Hierarchy (Ancestors)

Postoperative Complications; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Neurologic Manifestations; Signs and Symptoms

Central Study Contacts

Jing Yang Dr. Liou, MD

CONTACT

886+ 02-28767549; archmastertw@gmail.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER GOV
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: May 16, 2023
• First Posted: June 2, 2023
• Study Start: March 29, 2023
• Primary Completion: December 31, 2023
• Study Completion: December 31, 2024
• Last Updated: June 2, 2023

Record last verified: 2023-05

Data Sharing

• IPD Sharing: Will not share

Locations

TW (1)