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

Study Overview
=================
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: a sensation different from nociception, usual painkillers are ineffective, suggesting an alternative route of transmission, relieved by movement, 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.

Official Title
-----------------
The Role of Sngception and Pain in Enhanced Recovery After Surgery (ERAS) for Spine Surgeries

Conditions
-----------------
Pain Postoperative

Intervention / Treatment
-----------------
* Other: No specific intervention other than routine anesthesia protocol


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients undergoing routine ERAS protocol for spine surgeries American Society of Anesthesiologists Physical Status (ASA-PS) I III Exclusion Criteria: 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.

Ages Eligible for Study
-----------------
Minimum Age: 20 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| ERAS group<br>Routine spine surgical patients receiving ERAS protocol that complies with current guidelines. | Other: No specific intervention other than routine anesthesia protocol<br>* No specific intervention other than routine anesthesia protocol<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morphine consumption | Postoperative morphine consumption converted to Morphine Sulfate Equivalents (MSE) | From enrollment to discharge, an average of 5 days. | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
sng, enhanced recovery, ERAS, Spine surgery, pain, sngception