Developing novel technologies to monitor nociception and opioid administration during surgery and general anesthesia in order to minimize post-operative opioid requirements

PROJECT SUMMARY In light of the opioid crises, minimizing postoperative pain and postoperative opioid requirements to reduce chronic opioid dependency among surgical patients have become major concerns for surgeons and anesthesiologists. Effective intraoperative nociception control can mitigate these concerns. Unfortunately, existing nociceptive monitoring tools use indicators that are inherently susceptible to intraoperative influences. Monitoring these indicators often lead to suboptimal intraoperative opioid administration, since there is no way to account for whether these measures are being influenced by nociception or numerous other intraoperative factors such as blood loss, anesthetic drugs and antihypertensives. Therefore, improved methods to monitor surgical nociception are clearly needed. In short, currently available nociceptive monitors measure unreliable indicators and predispose surgical patients to suboptimal opioid dosing administration leading to ineffective intraoperative control. The consequences for surgical patients can be significant, since increased postoperative pain and opioid requirements is associated with increased incidence of opioid dependency. This project proposes to develop a state-of-the-art sensors, algorithms, and prospective observational data to construct an integrated measure of nociceptive control based on autonomic (EDA) and neurophysiologic markers of arousal and nociception (EEG-based arousal and opioid signatures).PROJECT NARRATIVE Effective nociception monitoring and control during surgery can minimize post-operative pain and reduce post- operative opioid requirements among surgical patients, thereby decreasing their chances of opioid dependency, but existing nociception monitoring tools are imperfect in that they monitor markers such as heart rate and blood pressure that are inherently influenced by various intraoperative factors. This leads to suboptimal opioid administration for nociception control. This project proposes to develop a novel surgical nociception monitor that comprises of an integrated measure of nociceptive control based on neurophysiological (EEG) and autonomic (EDA) markers of arousal and nociception that aren’t susceptible to intraoperative factors.