Perioperative Quantitative Sensory Testing and Incision Pain Mapping in Thoracic Surgery
Perioperative Pain Phenotyping and Incision Pain Mapping Using Quantitative Sensory Testing in Patients Undergoing Thoracoscopic or Robotic-assisted Lung Resection: A Prospective Observational Pilot Cohort Study
Postoperative pain remains a common and clinically important burden after thoracic surgery and may progress to chronic postsurgical pain. Conventional pain assessment mainly relies on patient-reported pain intensity and analgesic consumption, which may not fully capture peri-incisional sensory abnormalities, mechanical hyperalgesia, or central sensitization.
This prospective observational pilot cohort study aims to evaluate the feasibility and acceptability of perioperative quantitative sensory testing (QST) and incision pain mapping in adult patients undergoing elective thoracoscopic or robotic-assisted lung resection. Participants will undergo baseline assessment before surgery, serial postoperative pain assessments during the first 72 hours, QST and mechanical hyperalgesia pain mapping at 48-72 hours after surgery, and follow-up assessments at discharge, 1 month, and 3 months after surgery.
The primary feasibility outcomes include recruitment rate, QST completion rates, follow-up completion rates, QST-related discontinuation rate, study-related adverse events, and data completeness. The main clinical mechanistic outcome is the area of peri-incisional mechanical hyperalgesia at 48-72 hours after surgery. Secondary outcomes include acute postoperative pain intensity, pain burden over 72 hours, opioid consumption, quality of recovery, QST changes, pain-map characteristics, and chronic postsurgical pain at 3 months.
This study will not assign or modify therapeutic interventions. All anesthetic, surgical, and analgesic management will be determined by the routine clinical care team. The study is expected to provide feasibility data, preliminary effect estimates, and mechanistic information for future larger perioperative pain studies.
Tutkimuksen yleiskatsaus
Tila
Ehdot
Interventio / Hoito
Yksityiskohtainen kuvaus
This is a single-center, prospective, observational pilot cohort study conducted in adult patients scheduled to undergo elective thoracoscopic or robotic-assisted lung resection. The study is designed to characterize perioperative pain phenotypes using standardized quantitative sensory testing (QST), incision-centered mechanical hyperalgesia pain mapping, serial pain intensity assessments, analgesic exposure, psychological and sleep-related questionnaires, and exploratory inflammatory or plasma biomarker measurements.
Eligible participants will provide written informed consent before surgery. Baseline assessments will be performed 1-3 days before surgery and will include demographic and clinical data collection, baseline pain history, psychological and sleep-related questionnaires, preoperative QST, and blood sampling. QST will assess sensory function in the surgical-side thoracic region, contralateral mirror region, and a remote control site where applicable.
During the first 72 hours after surgery, resting and movement-related numeric rating scale pain scores will be collected at prespecified time points, together with perioperative anesthetic, regional block, surgical, analgesic, and recovery-related information. Opioid consumption will be converted to morphine milligram equivalents.
At 48-72 hours after surgery, participants will undergo core postoperative QST and incision-centered mechanical pain mapping. The pain map will be generated around the incision or main port site in eight radial directions. Standardized mechanical stimulation will be applied from normal surrounding skin toward the incision, and boundary points will be marked when the participant reports a transition from normal sensation to increased pain, sharpness, burning, or abnormal discomfort. These boundary points will be connected to estimate the area of mechanical hyperalgesia.
Additional assessments will be performed before discharge, at 1 month, and at 90 ± 14 days after surgery. Follow-up assessments will evaluate persistent pain, pain intensity, pain interference, neuropathic pain features, QST changes, pain-map characteristics, quality of recovery, and exploratory blood biomarkers. Chronic postsurgical pain will be assessed at 3 months after surgery and defined as new or worsened pain related to the surgical area, persisting for at least 3 months after surgery, and not better explained by other causes.
The study will not assign any therapeutic intervention. Surgical technique, anesthetic management, regional analgesia, postoperative analgesia, chest tube management, and perioperative care will follow routine clinical practice. Key perioperative variables will be prospectively collected and considered as potential confounders in statistical analyses.
Opintotyyppi
Ilmoittautuminen (Arvioitu)
Yhteystiedot ja paikat
Opiskeluyhteys
- Nimi: Ni Zhang, Dr
- Puhelinnumero: 8613871288490
- Sähköposti: nizhang@tjh.tjmu.edu.cn
Opiskelupaikat
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Hubei
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Wuhan, Hubei, Kiina, 430030
- Tongji Hospital
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Ottaa yhteyttä:
- Wei Ping, Dr.
- Puhelinnumero: 8613437101581
- Sähköposti: pingwei@tjh.tjmu.edu.cn
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Osallistumiskriteerit
Kelpoisuusvaatimukset
Opintokelpoiset iät
- Aikuinen
- Vanhempi Aikuinen
Hyväksyy terveitä vapaaehtoisia
Näytteenottomenetelmä
Tutkimusväestö
Kuvaus
Inclusion Criteria:
- Male
- Scheduled to undergo elective thoracoscopic or robotic-assisted lung resection.
- American Society of Anesthesiologists physical status I to III.
- Able to understand and communicate adequately and to complete study questionnaires independently or with assistance from study staff.
- Willing to undergo QST assessment, perioperative venous blood sampling, and postoperative follow-up.
- Able and willing to provide written informed consent.
Exclusion Criteria:
- Definite chronic chest wall, shoulder, back, or upper limb pain with an average 2. Numeric Rating Scale score of 3 or higher during the preceding week.
3. Definite painful neuropathic disease or long-term use of opioids or other analgesics for more than 2 weeks.
4. Peripheral neuropathy, spinal cord disease, or other neurological disease that may substantially interfere with interpretation of QST results.
5. Severe cognitive impairment, psychiatric disorder, communication disorder, or inability to complete questionnaires and QST assessments.
6. Active infection, active autoimmune disease, or other disease condition that may substantially affect inflammatory protein measurements.
7. Emergency surgery, conversion to open thoracotomy, extensive chest wall resection, or severe intraoperative complications.
8. Any condition that, in the opinion of the investigator, makes the participant unsuitable for continued participation in the study.
Opintosuunnitelma
Miten tutkimus on suunniteltu?
Suunnittelun yksityiskohdat
Kohortit ja interventiot
Ryhmä/Kohortti |
Interventio / Hoito |
|---|---|
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Elective Thoracoscopic or Robotic-assisted Lung Resection Cohort
Adult patients scheduled for elective thoracoscopic or robotic-assisted lung resection will be enrolled and followed prospectively from the preoperative period to 3 months after surgery.
Participants will undergo observational assessments including questionnaires, quantitative sensory testing, peri-incisional mechanical hyperalgesia pain mapping, serial postoperative pain assessments, analgesic exposure recording, and exploratory blood sampling.
No therapeutic intervention will be assigned by the investigators.
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Participants will undergo non-invasive perioperative quantitative sensory testing and incision-centered mechanical pain mapping at prespecified time points.
These assessments are observational and will not determine or modify clinical anesthesia, analgesia, or surgical management.
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Mitä tutkimuksessa mitataan?
Ensisijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Recruitment Rate
Aikaikkuna: Baseline
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Proportion of eligible patients who provide written informed consent and are enrolled in the study.
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Baseline
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Completion Rate of Baseline Quantitative Sensory Testing
Aikaikkuna: Preoperative period, 1 to 3 days before surgery
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Proportion of enrolled participants who complete the planned baseline QST assessment before surgery.
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Preoperative period, 1 to 3 days before surgery
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Completion Rate of Postoperative QST and Incision Pain Mapping
Aikaikkuna: 48 to 72 hours after surgery
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Proportion of enrolled participants who complete the core postoperative QST assessment and incision-centered mechanical hyperalgesia pain mapping.
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48 to 72 hours after surgery
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Completion Rate of 1-month Follow-up
Aikaikkuna: 1 month after surgery
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Proportion of enrolled participants who complete the planned 1-month postoperative follow-up assessment.
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1 month after surgery
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Completion Rate of 3-month Pain Outcome Follow-up
Aikaikkuna: 90 ± 14 days after surgery
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Proportion of enrolled participants who complete the primary 3-month postoperative pain outcome assessment.
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90 ± 14 days after surgery
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QST-related Discontinuation Rate
Aikaikkuna: From baseline assessment to 3 months after surgery
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Proportion of participants who discontinue QST or pain mapping prematurely because of pain intolerance, fatigue, anxiety, or other participant-related reasons.
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From baseline assessment to 3 months after surgery
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Study-related Adverse Event Rate
Aikaikkuna: From baseline assessment to 3 months after surgery
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Proportion of participants with study-related adverse events, including marked discomfort, transient pain exacerbation, local discomfort related to QST or pain mapping, or adverse events related to blood sampling.
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From baseline assessment to 3 months after surgery
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Data Completeness of Key Study Variables
Aikaikkuna: From baseline assessment to 3 months after surgery
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Proportion of missing data for key variables
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From baseline assessment to 3 months after surgery
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Toissijaiset tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Movement-related Pain Intensity During the First 72 Hours After Surgery
Aikaikkuna: 1, 6, 12, 18, 24, 32, 40, 48, 60, and 72 hours after surgery
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Movement-related pain intensity measured using an 11-point Numeric Rating Scale during turning in bed or active mobilization, where 0 indicates no pain and 10 indicates the worst imaginable pain.
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1, 6, 12, 18, 24, 32, 40, 48, 60, and 72 hours after surgery
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Resting Pain Intensity During the First 72 Hours After Surgery
Aikaikkuna: 1, 6, 12, 18, 24, 32, 40, 48, 60, and 72 hours after surgery
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Resting pain intensity measured using an 11-point Numeric Rating Scale, where 0 indicates no pain and 10 indicates the worst imaginable pain.
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1, 6, 12, 18, 24, 32, 40, 48, 60, and 72 hours after surgery
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Area of Peri-incisional Mechanical Hyperalgesia
Aikaikkuna: 48 to 72 hours after surgery
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Area of mechanical hyperalgesia around the surgical incision or main port site, measured in square centimeters using standardized incision-centered mechanical pain mapping.
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48 to 72 hours after surgery
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Area Under the Curve of Resting Pain Scores
Aikaikkuna: 0 to 72 hours after surgery
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Cumulative resting pain burden calculated as the area under the curve of serial resting Numeric Rating Scale pain scores during the first 72 postoperative hours.
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0 to 72 hours after surgery
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Area Under the Curve of Movement-related Pain Scores
Aikaikkuna: 0 to 72 hours after surgery
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Cumulative movement-related pain burden calculated as the area under the curve of serial movement-related Numeric Rating Scale pain scores during the first 72 postoperative hours
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0 to 72 hours after surgery
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Cumulative Opioid Consumption
Aikaikkuna: 0 to 72 hours after surgery
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Total postoperative opioid consumption during the first 72 hours after surgery, converted to morphine milligram equivalents.
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0 to 72 hours after surgery
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Quality of Recovery-15 Score
Aikaikkuna: 72 hours after surgery and before discharge
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Postoperative recovery quality assessed using the 15-item Quality of Recovery questionnaire.
Higher scores indicate better recovery.
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72 hours after surgery and before discharge
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Analgesia-related Adverse Effects
Aikaikkuna: 0 to 72 hours after surgery
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Incidence of analgesia-related adverse effects, including postoperative nausea and vomiting, excessive sedation, dizziness, or other analgesia-related symptoms.
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0 to 72 hours after surgery
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Time to First Ambulation
Aikaikkuna: Perioperative
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Time from the end of surgery to the first documented postoperative ambulation.
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Perioperative
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Chest Tube Duration
Aikaikkuna: Perioperative
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Duration of postoperative chest tube drainage, measured in hours or days.
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Perioperative
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Postoperative Length of Hospital Stay
Aikaikkuna: Perioperative
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Number of days from surgery to hospital discharge.
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Perioperative
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Perioperative Complications
Aikaikkuna: Perioperative
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Incidence of perioperative complications recorded during hospitalization
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Perioperative
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Change in Quantitative Sensory Testing Parameters
Aikaikkuna: Baseline, 48 to 72 hours after surgery, 1 month after surgery, and 90 ± 14 days after surgery
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Changes in QST parameters measured at the surgical-side thoracic region, contralateral mirror region, and remote control site when applicable.
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Baseline, 48 to 72 hours after surgery, 1 month after surgery, and 90 ± 14 days after surgery
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Maximum Radius of Peri-incisional Pain Map
Aikaikkuna: 48 to 72 hours after surgery, 1 month after surgery, and 90 ± 14 days after surgery
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Maximum radial distance from the incision or main port site to the boundary of mechanical hyperalgesia.
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48 to 72 hours after surgery, 1 month after surgery, and 90 ± 14 days after surgery
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Minimum Radius of Peri-incisional Pain Map
Aikaikkuna: 48 to 72 hours after surgery, 1 month after surgery, and 90 ± 14 days after surgery
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Minimum radial distance from the incision or main port site to the boundary of mechanical hyperalgesia.
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48 to 72 hours after surgery, 1 month after surgery, and 90 ± 14 days after surgery
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Incidence of Persistent Pain at 1 Month
Aikaikkuna: 1 month after surgery
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Proportion of participants reporting pain related to the surgical area at 1 month after surgery.
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1 month after surgery
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Incidence of Chronic Postsurgical Pain at 3 Months
Aikaikkuna: 90 ± 14 days after surgery
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Proportion of participants with new or worsened pain related to the surgical area persisting at 3 months after surgery and not better explained by other causes.
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90 ± 14 days after surgery
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Pain Interference at 3 Months
Aikaikkuna: 90 ± 14 days after surgery
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Pain-related interference with daily activity, sleep, and function assessed using the Brief Pain Inventory-short form.
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90 ± 14 days after surgery
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Neuropathic Pain Features at 3 Months
Aikaikkuna: 90 ± 14 days after surgery
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Neuropathic pain symptoms, such as numbness, burning pain, electric shock-like pain, or touch-evoked pain, assessed using the DN4 questionnaire and symptom interview.
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90 ± 14 days after surgery
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Muut tulostoimenpiteet
Tulosmittaus |
Toimenpiteen kuvaus |
Aikaikkuna |
|---|---|---|
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Psychological Factors and Postoperative Pain
Aikaikkuna: Baseline to 3 months after surgery
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Association of baseline psychological factors
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Baseline to 3 months after surgery
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Blood-based Inflammatory or Plasma Biomarkers
Aikaikkuna: Baseline, 48 ± 12 hours after surgery, before discharge, 1 month, and 90 ± 14 days after surgery when feasible
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Exploratory changes in inflammatory markers
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Baseline, 48 ± 12 hours after surgery, before discharge, 1 month, and 90 ± 14 days after surgery when feasible
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