Comparison of the nociceptive flexion reflex threshold and the bispectral index as monitors of movement responses to noxious stimuli under propofol mono-anaesthesia

Abstract

Movement responses to noxious stimuli under propofol can be predicted by the RIII threshold with a comparable accuracy as the BIS. Therefore, the RIII threshold seems to be influenced by hypnotic effects. Since susceptibility of the RIII threshold to analgesic influences is well established, an advantage for the RIII threshold in the prediction of motor responses could be expected when analgesic substances are used in addition to propofol.

Hypnosis for cingulate-mediated analgesia and disease treatment

“…The analgesic effect of the hypnotic procedure is not restricted to the cerebral cortex, as multiple subcortical regions are recruited in pain experience. Hypnoanalgesia effects altering the flow of noxious signals throughout the pain neuromatrix are evident from depletions in the nociceptive spinal reflex (R-III) supporting physiologic changes in the central nervous system associated with hypnoanalgesia (Kiernan et al, 1995) similar to those related to the hypnotic or sedative effect of anesthetics such as propofol (von Dincklage et al, 2009). These findings support a role in the suppression of movement during surgical procedures.…”

Utility of Nociceptive Flexion Reflex Threshold, Bispectral Index, Composite Variability Index and Noxious Stimulation Response Index as measures for nociception during general anaesthesia

“…Effect-compartment concentrations and NSRI also predict movement (but not heart rate) responses satisfactorily.Although the cerebral effect of hypnotics may be monitored using processed electroencephalography, no comparable monitor exists to measure nociception during general anaesthesia. In clinical practice, opioids are administered according to haemodynamic and movement responses to noxious stimuli [1].The correlation of such responses with the hypnotic depth as measured by the bispectral index (BIS) is relatively poor [2,3]. The composite variability index (CVI), which is derived from the BIS, may provide a better correlation and whereas promising results are presented in abstract form [4,5], no full research paper has yet been published.The nociceptive flexion reflex (NFR) is a polysynaptic spinal withdrawal reflex, which can be assessed by electromyography of the biceps femoris muscle…”

Higher doses of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption six months after total hip arthroplasty

“…Currently, a variety of different tools to measure intraoperative nociception and/or analgesia are under investigation in clinical studies. These are based on a wide range of physiological mechanisms including skin conductance (Storm, ), haemodynamics (Wennervirta et al., ; Rossi et al., ; Gruenewald et al., , ), electroencephalogram (Haenggi et al., ; Sahinovic et al., ) and a variety of nociceptive reflexes (von Dincklage et al., , , ; Paulus et al., ; Guglielminotti et al., ; Ly‐Liu and Reinoso‐Barbero, ; Jakuscheit et al., ). Currently, however, none of the tools have been shown to have enough specificity/sensitivity to outweigh the effort and cost of their routine clinical application (Gruenewald and Ilies, ; von Dincklage, ).…”