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

NCT ID: NCT05885802

Last Updated: 2023-06-02

Basic Information

• Recruitment Status: UNKNOWN
• Total Enrollment: 40 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2023-03-29
• Study Completion Date: 2024-12-31

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. a sensation different from nociception,

2. usual painkillers are ineffective, suggesting an alternative route of transmission,

3. relieved by movement,

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

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

ERAS group

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

No specific intervention other than routine anesthesia protocol

Intervention Type: OTHER

No specific intervention other than routine anesthesia protocol

Interventions

No specific intervention other than routine anesthesia protocol

No specific intervention other than routine anesthesia protocol

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

1. Patients undergoing routine ERAS protocol for spine surgeries

2. American Society of Anesthesiologists Physical Status (ASA-PS) I~III

Exclusion Criteria

1. Communication issues that preclude proper preoperative counselling for ERAS and study design.

2. Active alcohol or drug addiction.

3. Pregnancy

4. Allergy to main anesthetics that preclude the use of routine ERAS anesthesia management.

5. Patient refusal to participate in study.

6. Emergent operations.

• Minimum Eligible Age: 20 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

National Taiwan University Hospital

OTHER

Sponsor Role: collaborator

Taipei Veterans General Hospital, Taiwan

OTHER_GOV

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

Taipei Veterans General Hospital

Taipei City, Taipei, Taiwan

Site Status: RECRUITING

Countries

Taiwan

Central Contacts

Jing Yang Dr. Liou, MD

Role: CONTACT

archmastertw@gmail.com

886+ 02-28767549 ext. 368

Facility Contacts

Hsu Professor Ma, Ph.D.

Role: primary

irbopinion@vghtpe.gov.tw

+886 02 28712121

References

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.

Reference Type: BACKGROUND

PMID: 30486810 (View on PubMed)

Other Identifiers

IRB 2022-09-009BC

Identifier Type: -

Identifier Source: org_study_id