Remote Ischemic PreConditioning Effect on Postsurgical Pain (RIPCEPP)

Remote Ischemic Preconditioning (RIPC) and Its Effect on the Postoperative Pain Experience Following Intra-abdominal Surgery

Remote Ischemic PreConditioning (RIPC) will improve the postoperative pain experience in patients undergoing abdominal surgery. Although abdominal surgery can be a lifesaving procedure many people have a significant amount of postsurgical pain. Severe postsurgical pain may lead to chronic pain in some people. "Remote Ischemic Preconditioning" may reduce the amount of postsurgical pain. Remote ischemic preconditioning is done by inflating a balloon (very similar to a blood pressure cuff) on the leg until it blocks blood flow for a few minutes. The cuff is then deflated and blood flow resumes. The process is repeated up to three times. This procedure causes the body to increase its natural pain relief system that may help to decrease the amount of postsurgical pain.

A tourniquet on the thigh will be inflated to 300 mmHg for 5 minutes then deflated for 5 minutes. This will be repeated three times

A tourniquet on the thigh will be inflated to 15 mmHg for 5 minutes then deflated for 5 minutes. This will be repeated three times

Pain intensity and unpleasantness will be measured on postoperative day (POD) 1 and 2 by using a 0-10 verbal scale after asking the subject to cough. Higher scores denotes more intensity and unpleasantness of pain.

All opioids administered during postoperative day (POD) 1 and 2 will be recorded and the number of participants that used opioids will be given.

All non-opioids analgesics administered during postoperative day 1 and 2 will be recorded and the number of participants that used nonopiods will be given.

Number of participants that used an antiemetic postoperative day 1 and postoperative day 2 was recorded.

The Ramsey Sedation Scale (RSS) was used to determine the level of sedation. Th RSS defines the conscious state from a level 1: the patient is anxious, agitated or restless, through the continuum of sedation to a level 6: the patient is completely unresponsive. The score range is from 1-6, with higher scores denoting worse outcomes.

The McGill Pain Questionnaire (MPQ) is a three-part pain assessment tool that measures several dimensions of the patient's pain experience. The scale range is 0-78, with higher scores denoting worse outcomes.

Pain unpleasantness will be measured on postoperative day (POD) 1 and 2 by using a 0-10 verbal scale after asking the subject to cough. Higher scores denotes more intensity and unpleasantness of pain.

Inclusion Criteria: Ages 30-80 Undergoing elective open intra-peritoneal surgery Able to provide written informed consent to participate Laparoscopic abdominal surgery Exclusion Criteria: Ongoing Workman's Compensation claim >50mg/day of oral morphine or morphine equivalent Currently being treated for lower extremity DVT Known intracranial hypertension (not excluding patients with a functioning VP shunt) Known Hypercoagulable state (e.g. factor V Leiden, protein s or c deficiency) Ongoing localized thigh pain Planned epidural analgesia Pregnancy Any DSM IV-R Axis I psychotic disorders Unable to understand English Unable to understand the consent form