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The goal of this observational study is to learn about how regional anesthesia (numbing medication) affects pain in patients with different psychosocial phenotypes such as different levels of concern about pain, sleep issues, and anxiety, who are having surgery.
The main questions are:
A patient's psychological profile importantly modulates pain severity, and the overall experience and impact of pain. For instance, catastrophic thinking about pain, including magnification, rumination, and helplessness, is associated with both greater pain severity and impact.
Over the years, regional anesthesia has become an integral part of multimodal pain management for many surgeries. Regional anesthesia (epidural and peripheral nerve blocks) to be associated with superior pain control, reduced time to return of bowel function, shorter intraoperative times, fewer side effects and complications, earlier ambulation and functional exercise capacity post-discharge, lower in-hospital mortality, reduced length-of-stay, improved patient satisfaction, and fewer readmissions.
The investigators aim to use of validated psychosocial surveys and semi-structured interviews to understand the phenotype of patients who will benefit the most from regional anesthesia. The investigators also aim to understand how different patient phenotypes and regional anesthesia affect perioperative opioid consumption, and development of chronic postsurgical pain.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Thoracic surgery and open abdominal surgery | Patients who underwent surgery thoracic surgery or open abdominal surgery |
| |
| Orthopedic surgery | Patients who underwent orthopedic surgery |
| |
| Spine surgery | Patients who underwent spine surgery |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| regional anesthesia | Procedure | Patients who underwent surgery and received an epidural or peripheral nerve block |
|
| Measure | Description | Time Frame |
|---|---|---|
| Maximum pain score over the first 24 hours after surgery | Maximum pain score (numerical pain rating score 0-10) over the first 24 hours after surgery | 0-24 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Worst pain score over the first 24 hours after surgery | Worst pain score (numerical pain rating score 0-10) over the first 24 hours after surgery | 0-24 hours |
| Average pain score over the first 24 hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Incidence of chronic postsurgical pain | Comparison of persistent pain in the surgical area > 3 months after surgery | 3-12 months |
| Longitudinal pain scores | Comparison of pain scores (numerical pain rating score 0-10) at 1 month, 3 months, 6 months, and 12 months |
Inclusion Criteria:
Exclusion Criteria:
-Cognitive dysfunction that precludes communication
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All surgical patients are eligible for the study if they meet the inclusion/exclusion criteria. We plan to enroll patients who may or may not receive a nerve block placement (ex: epidural or peripheral nerve block) during their clinical care or have a surgery that may result in an acute postoperative pain consult (ex: spine and orthopedic surgery).
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Yun-Yun K Chen, MD | Contact | 617-651-0932 | ykchen@mgb.org |
| Name | Affiliation | Role |
|---|---|---|
| Robert Edwards, PhD | Brigham and Women's Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Brigham and Women's Hospital | Recruiting | Boston | Massachusetts | 02115 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33426669 | Background | Chen YK, Boden KA, Schreiber KL. The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: a narrative review. Anaesthesia. 2021 Jan;76 Suppl 1(Suppl 1):8-17. doi: 10.1111/anae.15256. | |
| 33452600 | Background | Schreiber KL, Zinboonyahgoon N, Flowers KM, Hruschak V, Fields KG, Patton ME, Schwartz E, Azizoddin D, Soens M, King T, Partridge A, Pusic A, Golshan M, Edwards RR. Prediction of Persistent Pain Severity and Impact 12 Months After Breast Surgery Using Comprehensive Preoperative Assessment of Biopsychosocial Pain Modulators. Ann Surg Oncol. 2021 Sep;28(9):5015-5038. doi: 10.1245/s10434-020-09479-2. Epub 2021 Jan 15. |
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| ID | Term |
|---|---|
| D059787 | Acute Pain |
| D010149 | Pain, Postoperative |
| ID | Term |
|---|---|
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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| ID | Term |
|---|---|
| D000765 | Anesthesia, Conduction |
| ID | Term |
|---|---|
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
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| no regional anesthesia | Procedure | Patients who underwent surgery and did not received an epidural or peripheral nerve block |
|
| acute pain consultation | Other | Patients who underwent surgery and had a perioperative (preop, intraop, or postop) acute pain consultation |
|
| no acute pain consultation | Other | Patients who underwent surgery and did not have a perioperative (preop, intraop, or postop) acute pain consultation |
|
Average pain score (numerical pain rating score 0-10) over the first 24 hours after surgery
| 0-24 hours |
| Least pain score over the first 24 hours after surgery | Least pain score (0-10) over the first 24 hours after surgery | 0-24 hours |
| Daily pain scores | Comparison of pain scores (numerical pain rating score 0-10) over the first 7 days after surgery | 0-7days |
| Postoperative opioid consumption | Comparison of amount of opioids used after surgery (morphine milliequivalents) | 0-7 days |
| 1-12 months |
| Perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS) | Comparison of social support at 7 days after surgery and 1 month postop versus baseline Scores range from 12 to 84, with higher scores indicating greater perceived support | 7 days to 1 month |
| pain catastrophizing using the pain catastrophizing scale (PCS) | Comparison of pain catastrophizing at 1 month, 3 months, 6 months and 12 months post op versus baseline Score range 0-52; higher scores indicate higher pain catastrophizing | 1 month-12 months |
| neuropathic pain using the Douleur Neuropathique en 4 Questions (DN4) | Comparison of neuropathic pain at 1 month, 3 months, 6 months and 12 months post op versus baseline Score 0-7, higher scores indicate higher neuropathic pain | 1 month-12 months |
| 16698416 | Background | Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006 May 13;367(9522):1618-25. doi: 10.1016/S0140-6736(06)68700-X. |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |