effect of perioperative dexmedetomidine on chronic post-surgical pain

Conditions: Chronic Post-Surgical Pain

Summary: the goal of this clinical trial is to learn if intranasal dexmedetomidine works to improve sleep quality to treat chronic post-surgical pain (cpsp) in patients undergoing thoracic surgery. it will also learn about the safety of intranasal dexmedetomidine.this clinical trial could include any of the following: adults aged 18-80 years, elective surgical patients scheduled for their first thoracoscopic lung resectiony, asa physical status i-iii, and sign the informed consent form. the main questions it aims to answer are: does intranasal dexmedetomidine reduce the incidence of cpsp in patients undergoing elective thoracic surgery? does perioperative sleep quality mediates the effect of intranasal dexmedetomidine in improving cpsp outcomes at 3 months post-surgery? what are the safety concerns or medical complications that participants may experience when using intranasal dexmedetomidine perioperatively? researchers will compare the intervention group receiving intranasal dexmedetomidine to a placebo (a look-alike substance that contains no drug) to assess its impact on perioperative sleep quality and the reduction in cpsp incidence at 3 months post-surgery. participants will: take the study drug (intranasal dexmedetomidine) or a placebo (saline) every night between 9:00-9:30 pm, starting the day before surgery and continuing until the day before discharge. after the drug administration, undergo 3 hours of continuous monitoring with ecg and wear a wearable device for ongoing assessment. cooperate with researchers to assess sedation, pain, sleep, emotional status, medication usage, adverse events, and postoperative recovery quality on postoperative days 1, 2, and 3 you will be contacted by phone at 1, 3, and 6 months by the research team to inquire about sleep, pain, medication use, and overall quality of life after discharge.


Eligibility criteria:
inclusion criteria: 1. adults aged 18-80 years, 2. elective surgical patients scheduled for their first thoracoscopic lung resectiony, 3. asa physical status i-iii 4. sign the informed consent form exclusion criteria: 1. severe heart failure or left ventricular ejection fraction (lvef) \<30%, or the presence of coronary artery disease, cardiac conduction abnormalities, or arrhythmias; 2. abnormal liver function, defined as alt \>100 iu/l or child-pugh class b; 3. renal insufficiency, characterized by an estimated glomerular filtration rate (egfr) \ 120 µmol/l; 4. a history of peptic ulcer disease, gastrointestinal bleeding, asthma, or cerebrovascular disease; 5. known allergy to medications potentially used in this study, including dexmedetomidine, propofol, opioids, nonsteroidal anti-inflammatory drugs (nsaids), or local anesthetics; 6. body mass index (bmi) \>30 kg/m²; 7. preoperatively diagnosed psychiatric disorders, such as anxiety, depression, or sleep disturbances; 8. long-term use of opioids or sedatives, defined as usage for 3 months or longer; 9. pregnant women, postpartum individuals, and breastfeeding mothers; 10. patients anticipated to require postoperative admission to the intensive care unit (icu); 11. patients with nasal abnormalities or conditions that preclude or contraindicate intranasal drug administration.