Could Preoperative Assessment of Physical and Psychological Status Help Predict Pain After Anorectal Surgery?
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ClinicalTrials.gov Identifier: NCT06049524 |
Recruitment Status :
Not yet recruiting
First Posted : September 22, 2023
Last Update Posted : October 6, 2023
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Condition or disease |
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Hemorrhoids Anal Fistula Anal Fissure Incontinence Pain Syndrome Postoperative Pain |
Study Type : | Observational [Patient Registry] |
Estimated Enrollment : | 200 participants |
Observational Model: | Cohort |
Time Perspective: | Prospective |
Target Follow-Up Duration: | 1 Month |
Official Title: | The Role of Preoperative Assessment of Physical and Psychological Status in the Development of Pain Syndrome in Patients After Anorectal Interventions. А Single-center Prospective Observational Study. |
Estimated Study Start Date : | January 8, 2024 |
Estimated Primary Completion Date : | July 1, 2024 |
Estimated Study Completion Date : | December 30, 2024 |
Group/Cohort |
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Experimental group
Prior to surgery all included patients are asked to fill out questionnaires in written or electronic form to collect the information. Then the participating doctor conducts a test to determine the pain threshold for pressure pain. Further the scheduled surgical intervention is performed under spinal anesthesia.Intraoperative data are also entered to the database. After surgery the researcher provides the patient with a written or electronic form of a postoperative monitoring questionnaire. In the postoperative period, patients undergo analgesia according to the standard scheme. In case of ineffectiveness of the standard anesthesia regimen 100 mg of tramadol is administered to the patient. All patients are remotely monitored 30 days after surgery to collect postoperative data, and if there are any remaining symptoms or complaints, they are invited to the clinic for examination.
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- Correlation between the preoperative pain threshold level and the intensity of the postoperative pain syndrome [ Time Frame: Day 15 after surgery ]The pain threshold is the point at which a subject begins to experience pain from an outward stimulus. The individual physiological level of pain threshold is assessed before surgery with a test determining the threshold for pressure pain. The intensity of the postoperative pain syndrome is assessed according to VAS scale during 15 days after surgery.
- The relationship between the physical factors and the intensity of the postoperative pain syndrome [ Time Frame: Day 15 after surgery ]Identification of predictors of the development of moderate and severe pain syndrome (pain level 5-10 points according to VAS) among physical factors (gender, age, BMI, smoking experience and smoking index)
- The relationship between the preoperative clinical factors and the intensity of the postoperative pain syndrome [ Time Frame: Day 15 after surgery ]Identification of predictors of the development of moderate and severe pain syndrome (pain level 5-10 points according to VAS) among preoperative clinical factors (symptoms of the existing disease, in case of pain - pain assessment according to VAS, duration of the disease, analgesics usage, previous interventions in the anorectal area, relapses of the disease, the day of the menstrual cycle in women, duration of the menstrual cycle, hormonal contraceptives usage, a history of new coronavirus infection (COVID-19 infection), the date and duration of the COVID-19 infection)
- The relationship between the perioperative clinical factors and the intensity of the postoperative pain syndrome [ Time Frame: Day 15 after surgery ]Identification of predictors of the development of moderate and severe pain syndrome (pain level 5-10 points according to VAS) among preoperative clinical factors (the final diagnosis, the type of surgical treatment, in the case of hemorrhoidectomy - the number of removed hemorrhoids)
- The correlation between the severity of pain syndrome and psychological factors before surgery [ Time Frame: Before surgery ]Psychological factors include anxiety and depression. To assess anxiety and depressive syndrome, the scales for self-assessment of anxiety SAS (The Zung Self-Rating Anxiety Scale) and depression SDS (The Zung Self-Rating Depression Scale) is used.
- The correlation between the severity of pain syndrome and psychological factors after surgery. [ Time Frame: Day 7 after surgery ]Psychological factors include anxiety and depression. To assess anxiety and depressive syndrome, the scales for self-assessment of anxiety SAS (The Zung Self-Rating Anxiety Scale) and depression SDS (The Zung Self-Rating Depression Scale) is used.
- The correlation between the severity of pain syndrome and psychological factors after surgery. [ Time Frame: Day 30 after surgery ]Psychological factors include anxiety and depression. To assess anxiety and depressive syndrome, the scales for self-assessment of anxiety SAS (The Zung Self-Rating Anxiety Scale) and depression SDS (The Zung Self-Rating Depression Scale) is used.
- Analgesics usage [ Time Frame: During 7 days after surgery ]The frequency of administration and the number of analgesics taken, including opioids
- Pain Disability [ Time Frame: Before surgery ]If patient has a pain caused by anorectal disease, the impact of the pain on the quality of life will be evaluated according to the scale of assessment of the degree of disability due to pain (Pain Disability Index).
- Pain Disability [ Time Frame: Day 7 after surgery ]The impact of postoperative pain on the quality of life is evaluated according to the scale of assessment of the degree of disability due to pain (Pain Disability Index).
- Pain Disability [ Time Frame: Day 30 after surgery ]The impact of postoperative pain on the quality of life is evaluated according to the scale of assessment of the degree of disability due to pain (Pain Disability Index).
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Ages Eligible for Study: | 18 Years and older (Adult, Older Adult) |
Sexes Eligible for Study: | All |
Gender Based Eligibility: | Yes |
Gender Eligibility Description: | Our clinic specializes only in the adult population |
Accepts Healthy Volunteers: | No |
Sampling Method: | Non-Probability Sample |
Inclusion Criteria:
- Patients over 18 years old
- Diagnosed benign anorectal disease requiring surgical treatment: hemorrhoidal disease of stage 2-4, anal fissure that does not respond to conservative treatment, rectal and rectovaginal fistulas with or without drainage ligature, post-traumatic failure of the anal sphincter, as well as other types of failure of the anal sphincter.
- One of the planned interventions: open/closed hemorrhoidectomy with or without Ligasure, excision of the anal fissure, excision of the rectum or rectovaginal fistula of the rectum with or without segmental proctoplasty, sphincterolevatoroplasty or other options for reconstruction of the anal sphincter.
- Indications for planned surgical treatment
- Absence of other diseases that cause pain syndrome.
- I, II class of anesthetic risk according to ASA classification
- Voluntary signing by the participant of an informed consent for surgical treatment and participation in a clinical trial.
Exclusion Criteria:
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The chronic pain syndrome unrelated to the main proctological disease, exacerbation of concomitant diseases with pain syndrome
- Chronic or prolonged use of medications, including narcotic drugs, with analgesic effect for other diseases.
- Patients who have contraindications or technical impossibility of performing subarachnoid anesthesia or the full standard volume of surgery for the corresponding disease.
- The presence of previously diagnosed mental and neurological disorders.
- Patients who refused to participate at any time before the end of the study, as well as patients who did not pass the final postoperative monitoring (1 month after the intervention).
- Pregnant women
- Complicated course of the postoperative period
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT06049524
Contact: Tatiana Garmanova, PhD | +79773429249 | tatianagarmanova@gmail.com | |
Contact: Ekaterina Kazachenko | ekaterina.k.97@mail.ru |
Russian Federation | |
the surgical department of the Medical Research and Educational Center of Lomonosov Moscow State University (MREC MSU) | |
Moscow, Russian Federation, 119991 | |
Contact: Tatiana Garmanova, PhD tatianagarmanova@gmail.com | |
Contact: Ekaterina Kazachenko ekaterina.k.97@mail.ru |
Responsible Party: | Center of Endourology "Endocenter" |
ClinicalTrials.gov Identifier: | NCT06049524 |
Other Study ID Numbers: |
102458296 |
First Posted: | September 22, 2023 Key Record Dates |
Last Update Posted: | October 6, 2023 |
Last Verified: | October 2023 |
Individual Participant Data (IPD) Sharing Statement: | |
Plan to Share IPD: | No |
Studies a U.S. FDA-regulated Drug Product: | No |
Studies a U.S. FDA-regulated Device Product: | No |
postoperative analgesia preoperative assessment anorectal surgery pain threshold postoperative pain predictor |
Hemorrhoids Rectal Fistula Fissure in Ano Syndrome Pain, Postoperative Fistula Disease Pathologic Processes Postoperative Complications Pain Neurologic Manifestations |
Pathological Conditions, Anatomical Rectal Diseases Intestinal Diseases Gastrointestinal Diseases Digestive System Diseases Vascular Diseases Cardiovascular Diseases Intestinal Fistula Digestive System Fistula Anus Diseases |