Chronic pain, functional impairment and slow rates of recovery are key issues for patients
after surgery and trauma. No preventative strategy in current use unequivocally modifies
these rates, and few novel approaches have been tested. Furthermore, persistent postsurgical
pain is a major route to chronic opioid use, opioid use disorder and, regrettably, opioid
overdose. Most strategies designed to limit chronic pain or enhance functional recovery after
surgery are directed at modulating peripheral and central nervous system activity and do not
strongly modify the underlying tissue pathophysiology or fundamental systemic responses.
Strategies limiting oxidative stress in the perioperative period, on the other hand, might
limit tissue damage, organ dysfunction and immune system activation.
N-acetyl cysteine (NAC) is an antioxidant well-studied in the perioperative period; it is
very safe, relatively inexpensive and widely available. The central hypothesis is, therefore,
that perioperative administration of NAC will reduce perioperative oxidative stress, limit
immune system activation and improve key indices of surgical recovery. Although the planned
work will not comprehensively address this hypothesis, it will identify the most useful tools
and help the researchers estimate the required sample sizes for more definitive externally
funded efforts.