Monitoring of nociception: is more always more?

Dincklage, Falk von; Ledowski, Thomas

doi:10.1016/j.bja.2020.11.014

Cited by 7 publications

(8 citation statements)

References 2 publications

(2 reference statements)

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“…Many technological solutions based on other clinical changes as a peripheral (skin) sympathetic tone, galvanic response (sympathetic tone), plethysmographic pulse waves (sympathetic vascular tone), temperature, and peripheral vascular and cardiac sympathetic tone are available for pain detection during general anaesthesia. [50][51][52] Effective analgesia is crucial for perioperative safety. Uncontrolled postoperative pain disturbs the reconvalescence process and induces pulmonary and circulatory complications and postoperative stress.…”

Section: Discussionmentioning

confidence: 99%

Are There Any Advantages of the Low Opioid Anaesthesia and Non-Opioid Postoperative Analgesia Protocol: A Clinical Observational Study

Kościuczuk,

Tarnowska,

Rynkiewicz-Szczepanska

2024

JPR

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The methods of perioperative analgesia and pain control have changed. The principle of opioid-based analgesia has been modified to multimodal analgesia, followed by LOA (low opioid anaesthesia) and OFA (opioid-free anaesthesia). The aim was to describe the effects of LOA on nausea, vomiting, and pain control during general anaesthesia and postoperative period after laparoscopic cholecystectomy. Patients and Methods:The protocol included the study group-40 patients received low-opioid anaesthesia (LOA), and the control group-40 patients received general anaesthesia with opioid analgesia (OA). The scheme of LOA was based on ketamine, lidocaine, magnesium sulfate, paracetamol, and metamizole. The OA was based on standard opioid (fentanyl) administration in induction and maintenance phase due to clinical observation. Postoperative analgesia included 1g of paracetamol and 1g of metamizol intravenously, with a 6-hour interval between doses. Results: Significant differences in the pain score in the periods of 2-6, 6-12, and 12-24 hours after anaesthesia between the groups were noticed (p < 0.001). Moreover, a significant difference in the frequency of nausea (p = 0.005) and vomiting (p = 0.04) between groups were presented. Nausea occurred in 54.05% of OA group, while in the LOA group, it occurred in a 23.08%. Vomiting occurred in 32.43% of control group, while in the study group, it occurred in 12.82% of patients. Conclusion:The LOA protocol was more beneficial in reducing nausea and vomiting than the opioid-based method of anaesthesia. The LOA protocol of general anaesthesia during laparoscopic cholecystectomy and non-opioid postoperative analgesia have better outcomes in pain control, as well as nausea and vomiting, and improve postoperative patient comfort. The LOA protocol during anaesthesia and non-opioid postoperative analgesia should be considered in routine practice.

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Section: Discussionmentioning

confidence: 99%

Are There Any Advantages of the Low Opioid Anaesthesia and Non-Opioid Postoperative Analgesia Protocol: A Clinical Observational Study

Kościuczuk,

Tarnowska,

Rynkiewicz-Szczepanska

2024

JPR

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“…Different monitoring devices have been shown to detect nociceptive inputs or the application of analgesic drugs. There is no consensus on selecting adequate outcome parameters to evaluate the efficacy of nociception monitoring [13]. We suggest that not only immediate, but also long‐term effects (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review suggested that nociception level index might be superior to standard heart rate and blood pressure monitoring for the detection of nociceptive stimuli [12]. Despite promising initial studies, it remains controversial whether the nociception level index meaningfully improves relevant postoperative outcomes such as postoperative pain [13].…”

Section: Introductionmentioning

confidence: 99%

“…A recent meta‐analysis examining various nociceptive monitors reported that these technologies may facilitate intra‐operative opioid titration, thereby decreasing cumulative doses compared with standard practice [14]. In the broader context of multimodal analgesia, absolute differences in intra‐operative opioid administration may be valid measures within specific organisational structures or departments, but may not necessarily be generalisable to other centres [13]. We propose postoperative pain values and opioid requirements as an alternative metric to examine the clinical utility of nociception level index in tailoring analgesia.…”

Section: Introductionmentioning

confidence: 99%

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Effect of nociception level index‐guided intra‐operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta‐analysis

Bornemann‐Cimenti,

Lang‐Illievich,

Kovalevska

et al. 2023

Anaesthesia

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SummaryAcute postoperative pain remains a critical treatment priority and has prompted a search for technologies and techniques to assist with intra‐operative analgesic monitoring and management. Anaesthetists traditionally rely on clinical judgement to guide intra‐operative analgesia, but several emerging technologies such as the nociception level index herald the possibility of routine intra‐operative analgesia monitoring. However, the impact of devices like nociception level index on postoperative outcomes has not been proven. We undertook a systematic review and meta‐analysis of articles which compared nociception level index‐guided analgesia to standard care. The primary outcomes were pain intensity and opioid consumption during the first 60–120 min after surgery. Secondary outcomes were the incidence of postoperative nausea and vomiting and duration of stay in the post‐anaesthesia care unit. Ten studies, collectively including 662 patients and published between 2019 and 2023, met inclusion criteria for both the qualitative systematic review and quantitative meta‐analysis. Risk of methodological bias was generally low or unclear, and six studies reported a significant conflict of interest relevant to their findings. Our meta‐analysis was performed using a random‐effects model. It found statistically significant benefits of nociception level index‐guided analgesia for early postoperative pain (mean (95%CI) difference ‐0.46 (‐0.88 to ‐0.03) on an 11‐point scale, p = 0.03), and opioid requirement (mean (95%CI) difference ‐1.04 (‐1.94 to ‐0.15) mg intravenous morphine equivalent, p = 0.02). Our meta‐analysis of the current literature finds that nociception level index‐guided analgesia statistically significantly reduces reported postoperative pain intensity and opioid consumption but fails to show clinically relevant outcomes. We found no evidence that nociception level index‐guided analgesia affected postoperative nausea and vomiting nor duration of stay in the post‐anaesthesia care unit.

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“…A person’s report of an experience as pain should be respected [ 1 ]. However, there to date is no objective and absolute measure of nociception and pain [ 2 ], and there is no gold standard to quantify nociception [ 3 ]. To evaluate pain intensity, several subjective and numerical indications [e.g., Numerical Rating Scale (NRS), Visual Analogue Scale (VAS)] are commonly used in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

Analgesia nociception index and high frequency variability index: promising indicators of relative parasympathetic tone

2022

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At present, there is no objective and absolute measure of nociception, although various monitoring techniques have been developed. One such technique is the Analgesia Nociception Index (ANI), which is calculated from heart rate variability that reflects the relative parasympathetic tone. ANI is expressed on a non-unit scale of 0–100 (100 indicates maximal relative parasympathetic tone). Several studies indicated that ANI-guided anesthesia may help reduce intraoperative opioid use. The usefulness of ANI in the intensive care unit (ICU) and during surgery has also been reported. However, some limitations of ANI have also been reported; for example, ANI is affected by emotions and some drugs. In 2022, a high frequency variability index (HFVI), which was renamed from ANI and uses the same algorithm as ANI, was commercialized; therefore, ANI/HFVI are currently in the spotlight. Unlike ANI, HFVI can be displayed along with other biometric information on the Root ® monitor. ANI/HFVI monitoring may affect the prognosis of not only patients in the perioperative period but those in ICU, those who receive home medical care, or outpatients. In this article, we present an updated review on ANI that has been published in the last decade, introduce HFVI, and discuss the outlooks of ANI/HFVI.

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Monitoring of nociception: is more always more?

Cited by 7 publications

References 2 publications

Are There Any Advantages of the Low Opioid Anaesthesia and Non-Opioid Postoperative Analgesia Protocol: A Clinical Observational Study

Are There Any Advantages of the Low Opioid Anaesthesia and Non-Opioid Postoperative Analgesia Protocol: A Clinical Observational Study

Effect of nociception level index‐guided intra‐operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta‐analysis

Analgesia nociception index and high frequency variability index: promising indicators of relative parasympathetic tone

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