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

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

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.

Study Overview

• Status: Recruiting
• Conditions: Pain Postoperative
• Intervention / Treatment: Other: No specific intervention other than routine anesthesia protocol

• Study Type: Observational
• Enrollment (Estimated): 40

Contacts and Locations

• Study Contact: Name: Jing Yang Dr. Liou, MD; Phone Number: 368 886+ 02-28767549; Email: archmastertw@gmail.com

Study Locations

• Taiwan
  • Taipei
    • Taipei City, Taipei, Taiwan, 11217
      • Recruiting
      • Taipei Veterans General Hospital
      • Contact: Hsu Professor Ma, Ph.D.; Phone Number: +886 02 28712121; Email: irbopinion@vghtpe.gov.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

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

Description

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.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
ERAS group; Routine spine surgical patients receiving ERAS protocol that complies with current guidelines.	Other: No specific intervention other than routine anesthesia protocol; No specific intervention other than routine anesthesia protocol

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.

Collaborators and Investigators

• Sponsor: Taipei Veterans General Hospital, Taiwan
• Collaborators: National Taiwan University Hospital

Publications and helpful links

General Publications

• 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.

Study record dates

Study Major Dates

• Study Start (Actual): March 29, 2023
• Primary Completion (Estimated): December 31, 2023
• Study Completion (Estimated): December 31, 2024

Study Registration Dates

• First Submitted: May 16, 2023
• First Submitted That Met QC Criteria: May 31, 2023
• First Posted (Actual): June 2, 2023

Study Record Updates

• Last Update Posted (Actual): June 2, 2023
• Last Update Submitted That Met QC Criteria: May 31, 2023
• Last Verified: May 1, 2023

More Information

Terms related to this study

• Keywords: pain; ERAS; Spine surgery; enhanced recovery; sngception; sng
• Additional Relevant MeSH Terms: Pathologic Processes; Postoperative Complications; Pain; Neurologic Manifestations; Pain, Postoperative; Physiological Effects of Drugs; Central Nervous System Depressants; Anesthetics
• Other Study ID Numbers: IRB 2022-09-009BC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No