Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial

Chan, Matthew T. V.; Peyton, Philip J; Myles, Paul S.; Leslie, Kate; Buckley, Norman; Kasza, Jessica; Paech, Mike; Beattie, W. Scott; Di, Sessler; Forbes, Andrew Benjamin; Wallace, Sophia; Chen, Y; Tian, Yuanyuan; Wu, William Ka Kei

doi:10.1093/bja/aew338

Cited by 39 publications

(28 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, the use of nerve blocks could have neutralized any detectable difference in pain scores. It is also hypothesized that certain patient populations may benefit more than others from the NMDA‐antagonistic effects of N 2 O, and it is possible that our patient cohort did not reflect that …”

Section: Discussionmentioning

confidence: 99%

Nitrous oxide anesthetic versus total intravenous anesthesia for functional endoscopic sinus surgery

et al. 2019

View full text Add to dashboard Cite

Background: Functional endoscopic sinus surgery is a common procedure for sinonasal disease, frequently performed in the outpatient setting. General anesthesia maintained with total intravenous anesthesia (TIVA) with propofol has been shown to give superior surgical conditions compared to inhaled anesthetics. This study evaluated the effects of TIVA versus a predominantly nitrous oxide (N 2 O)-based anesthetic with a low-dose propofol and remifentanil infusion on sinus surgery.Methods: Patients were randomized to either a N 2 O-based (nitrous oxide with propofol and remifentanil) or TIVA (propofol and remifentanil without nitrous oxide) group. The surgeon was blinded to the anesthetic technique. Surgical field grading was performed in real time by the otolaryngologist every 15 minutes with the Boezaart grading system.Results: There were no statistically significant differences between the Boezaart scores, duration of surgery, or estimated blood loss between the two anesthetic techniques. However, the use of N 2 O provided a statistically significant, 38% reduction in time from surgery end to extubation. The TIVA group had significantly decreased mean and median pain scores in the post-anesthesia care unit (PACU). There was no difference in the rate of postoperative nausea and vomiting between the two groups.Conclusion: A N 2 O-based anesthetic for functional endoscopic sinus surgery provides similar intraoperative and postoperative conditions when compared to TIVA, while being superior in terms of time to extubation. Although the TIVA group had significantly decreased pain scores, this did not lead to a decrease in pain medicine received in the PACU, and there was no difference between groups in time to discharge.

show abstract

Section: Discussionmentioning

confidence: 99%

Nitrous oxide anesthetic versus total intravenous anesthesia for functional endoscopic sinus surgery

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Post-discharge follow-up was done via telephone contact at three and six months postoperatively using a structured interview, a model which was extensively tested in follow-up studies in previous large multicentre trials in anaesthesia 4,5,[30][31][32][33] . At the three-month follow-up, patients were asked if they had experienced pain in the area of the surgery in the preceding month.…”

Section: Data Collectionmentioning

confidence: 99%

“…We defined our primary endpoint (CPSP) as the presence of pain in the area of the surgery in the preceding month reported by the patient at the six-month follow-up contact on an intention-to-treat basis 4,5 . Our null hypothesis was that IV ketamine given before and following surgical incision does not reduce the incidence of CPSP in our population sample.…”

Section: Data Collectionmentioning

confidence: 99%

The Effect of a Perioperative Ketamine Infusion on the Incidence of Chronic Postsurgical Pain—A Pilot Study

Peyton

Jacobson

et al. 2017

Anaesth Intensive Care

Self Cite

View full text Add to dashboard Cite

Chronic postsurgical pain (CPSP) is a common and debilitating complication of major surgery. We undertook a pilot study at three hospitals to assess the feasibility of a proposed large multicentre placebo-controlled randomised trial of intravenous perioperative ketamine to reduce the incidence of CPSP. Ketamine, 0.5 mg/kg pre-incision, 0.25 mg/kg/hour intraoperatively and 0.1 mg/kg/hour for 24 hours, or placebo, was administered to 80 patients, recruited over a 15-month period, undergoing abdominal or thoracic surgery under general anaesthesia. The primary endpoint was CPSP in the area of the surgery reported at six-month telephone follow-up using a structured questionnaire. Fourteen patients (17.5%) reported CPSP (relative risk [95% confidence interval] if received ketamine 1.18 [0.70 to 1.98], P=0.56). Four patients in the treatment group and three in the control group reported ongoing analgesic use to treat CPSP and two patients in each group reported their worst pain in the previous 24 hours at ≥3/10 at six months. There were no significant differences in adverse event rates, quality of recovery scores, or cumulative morphine equivalents consumption in the first 72 hours. Numeric Rating Scale pain scores (median [interquartile range]) for average pain in the previous 24 hours among those patients reporting CPSP were 17.5 [0 to 40] /100 with no difference between treatment groups. A large (n=4,000 to 5,000) adequately powered multicentre trial is feasible using this population and methodology.

show abstract

“…27 A sub-study of the ENIGMA1 trial 28 suggested that patients receiving general anaesthesia including nitrous oxide were less likely to develop chronic postsurgical pain 29 however this was not confirmed in a larger investigation using ENIGMA2 patients. 30 The possibility that an effect may exist in genetically distinct groups of patients requires further investigation. 30 Recently, nitrous oxide has emerged as a candidate therapy for treatment-resistant major depression.…”

Section: Recent Developments Regarding Licensed Hypnoticsmentioning

confidence: 99%

“…30 The possibility that an effect may exist in genetically distinct groups of patients requires further investigation. 30 Recently, nitrous oxide has emerged as a candidate therapy for treatment-resistant major depression. 31 32 Fospropofol This water-soluble propofol pro-drug 33 was developed to reduce the frequency of pain on injection during induction of anaesthesia/sedation and to offer a sustained period of hypnotic effect as the prodrug is progressively converted to propofol and formaldehyde.…”

Section: Recent Developments Regarding Licensed Hypnoticsmentioning

confidence: 99%

Thiopental to desflurane - an anaesthetic journey. Where are we going next?

Sneyd

2017

British Journal of Anaesthesia

View full text Add to dashboard Cite

Development targets in anaesthetic pharmacology have evolved from minimizing harm caused by unwanted effects through an era in which rapid onset and offset of drug effect were prioritised. Today's anaesthetists have access to a library of effective drugs whose characteristics offer controllable hypnosis, analgesia and paralysis with manageable off-target effects. The availability of these agents at generic prices inhibits commercial interest and this is reflected in the limited number of current anaesthetic drug development projects. Recently, questions around neonatal neurotoxicity, delirium and postoperative cognitive dysfunction have stimulated research to characterise these phenomena and explain them in mechanistic terms. Emergent basic science from these enquiries together with exploration of possible effects of anaesthetic drug choice on patient outcomes from cancer surgery may yield new targets for drug discovery.

show abstract

Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial

Abstract: NCT00430989.

Cited by 39 publications

References 42 publications

Nitrous oxide anesthetic versus total intravenous anesthesia for functional endoscopic sinus surgery

Nitrous oxide anesthetic versus total intravenous anesthesia for functional endoscopic sinus surgery

The Effect of a Perioperative Ketamine Infusion on the Incidence of Chronic Postsurgical Pain—A Pilot Study

Thiopental to desflurane - an anaesthetic journey. Where are we going next?

Contact Info

Product

Resources

About