Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

Berthoud, Vivien; Nguyen, Maxime; Appriou, Anouck; Ellouze, Omar; Radhouani, Mohamed; Constandache, Tiberiu; Grosjean, Sandrine; Durand, Bastien; Gounot, Isabelle; Bahr, Pierre-Alain; Martin, Audrey; Nowobilski, Nicolas; Bouhemad, Bélaïd; Guinot, Pierre-Grégoire

doi:10.1038/s41598-020-78221-5

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…4 It is common practice to use high doses of opioids in cardiac surgery, 7 but opioid titration using nociceptive monitoring systems has shown that the dose can be safely and significantly decreased. 12,30 The lower the dose of sufentanil, the lower may be the risk of opioid side effects. 30 Such effects may also be demonstrated by the intraoperative nonutilization of opioids during the surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The number of patients with acute renal injury (177 patients versus 178 patients, P = 1), pneumoniae (59 patients versus 42 patients, P = .104), and death (34 patients versus 34 patients, P = 1) did not differ between the 2 groups (Table 3). The balanced nonopioid general anesthesia group had shorter ICU stays (2 [1-3] days versus 3 [1][2][3][4] days, P = .001), but the overall hospital LOS did not significantly differ (8 days [7][8][9][10][11][12] versus 9 days [7][8][9][10][11][12]; P = .790).…”

Section: Secondary End Pointsmentioning

confidence: 99%

“…Arterial hypertension (systolic arterial pressure >140 mm Hg) was treated with esmolol in case of tachycardia (heart rate >80 bpm) or urapidil/nicardipine in case of heart rate <80 bpm. 4,12 All patients had locoregional analgesia by ultrasound-guided serratus anterior plane block (thoracotomy) or parasternal block (CABG surgery by sternotomy) or transversus thoracis muscle plane block (all other indication by sternotomy) with a local anesthetic (levobupivacaine 0.125 mg mL -1 or ropivacaine 2 mg mL -1 , 0.5 mL kg -1 ). 13 Locoregional analgesia was performed before the beginning of the surgery.…”

Section: Operative Managementmentioning

confidence: 99%

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Balanced Nonopioid General Anesthesia With Lidocaine Is Associated With Lower Postoperative Complications Compared With Balanced Opioid General Anesthesia With Sufentanil for Cardiac Surgery With Cardiopulmonary Bypass: A Propensity Matched Cohort Study

Guinot

Andrei

Durand

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: There are no data on the effect of balanced nonopioid general anesthesia with lidocaine in cardiac surgery with cardiopulmonary bypass. The main study objective was to evaluate the association between nonopioid general balanced anesthesia and the postoperative complications in relation to opioid side effects. METHODS: Patients undergoing cardiac surgery with cardiopulmonary bypass between 2019 and 2021 were identified. After exclusion of patients for heart transplantation, left ventricular assistance device, and off-pump surgery, we classified patients according to an opioid general balanced anesthesia or a nonopioid balanced anesthesia with lidocaine. The primary outcome was a collapsed composite of postoperative complications that comprise respiratory failure and confusion, whereas secondary outcomes were acute renal injury, pneumoniae, death, intensive care unit (ICU), and hospital length of stay. RESULTS: We identified 859 patients exposed to opioid-balanced general anesthesia with lidocaine and 913 patients exposed to nonopioid-balanced general anesthesia. Propensity score matching yielded 772 individuals in each group with balanced baseline covariates. Two hundred thirty-six patients (30.5%) of the nonopioid-balanced general anesthesia versus 186 patients (24.1%) presented postoperative composite complications. The balanced lidocaine nonopioid general anesthesia group was associated with a lower proportion with the postoperative complication composite outcome OR, 0.72 (95% CI, 0.58–0.92; P = .027). The number of patients with acute renal injury, death, and hospital length of stay did not differ between the 2 groups. CONCLUSIONS: A balanced nonopioid general anesthesia protocol with lidocaine was associated with lower odds of postoperative complication composite outcome based on respiratory failure and confusion.

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Section: Discussionmentioning

confidence: 99%

Section: Secondary End Pointsmentioning

confidence: 99%

Section: Operative Managementmentioning

confidence: 99%

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Balanced Nonopioid General Anesthesia With Lidocaine Is Associated With Lower Postoperative Complications Compared With Balanced Opioid General Anesthesia With Sufentanil for Cardiac Surgery With Cardiopulmonary Bypass: A Propensity Matched Cohort Study

Guinot

Andrei

Durand

et al. 2023

Anesthesia &Amp; Analgesia

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“…These made compelling arguments to apply the NOL index only until CPB initiation, providing a window of objectivity long enough to assess the block success and fine-tune opioid administration in both study arms. To date, only two other studies monitored nociception intraoperatively in cardiac surgery [ 22 , 23 ]. Interestingly, both used the pupillary pain index and reported reduced sufentanil consumption.…”

Section: Discussionmentioning

confidence: 99%

Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial

2023

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Background and Objectives: The erector spinae plane block (ESPB) is an analgesic adjunct demonstrated to reduce intraoperative opioid consumption within a Nociception Level (NOL) index-directed anesthetic protocol. We aimed to examine the ESPB effect on the quality of intraoperative nociception control evaluated with the NOL index. Materials and Methods: This is a post hoc analysis of the NESP (Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery) randomized controlled trial. Eighty-five adult patients undergoing on-pump cardiac surgery were allocated to group 1 (Control, n = 43) and group 2 (ESPB, n = 42). Both groups received general anesthesia. Preoperatively, group 2 received bilateral single-shot ESPB (1.5 mg/kg/side 0.5% ropivacaine mixed with dexamethasone 8 mg/20 mL). Until cardiopulmonary bypass (CPB) was initiated, fentanyl administration was individualized using the NOL index. The NOL index was compared at five time points: pre-incision (T1), post-incision (T2), pre-sternotomy (T3), post-sternotomy (T4), and pre-CPB (T5). On a scale from 0 (no nociception) to 100 (extreme nociception), a NOL index > 25 was considered an inadequate response to noxious stimuli. Results: The average NOL index across the five time points in group 2 to group 1 was 12.78 ± 0.8 vs. 24.18 ± 0.79 (p < 0.001). The NOL index was significantly lower in the ESPB-to-Control group at T2 (12.95 ± 1.49 vs. 35.97 ± 1.47), T3 (13.28 ± 1.49 vs. 24.44 ± 1.47), and T4 (15.52 ± 1.49 vs. 34.39 ± 1.47) (p < 0.001) but not at T1 and T5. Compared to controls, significantly fewer ESPB patients reached a NOL index > 25 at T2 (4.7% vs. 79%), T3 (0% vs. 37.2%), and T4 (7.1% vs. 79%) (p < 0.001). Conclusions: The addition of bilateral single-shot ESPB to general anesthesia during cardiac surgery improved the quality of intraoperative nociception control according to a NOL index-based evaluation.

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“…A PPI of 1 to 3, 4 to 6, or 7 to 9 describes numbed PDR and deep analgesia, medium PDR and suboptimal analgesia, and highly reactive PDR and uncontrolled pain, respectively. A decrease in the use of opioids was detected when this score was used as a criterion during intraoperative administration of opioids [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of the pupillary pain index as a guide for depth of analgesia during opioid-sparing anesthesia with continuous infusion of dexmedetomidine

Stefanini

Cagnazzi

Calza

et al. 2023

J Anesth Analg Crit Care

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Background The pupillary dilation reflex (PDR) is an objective indicator of analgesic levels in anesthetized patients. Through measurement of the PDR during increasing tetanic stimulation (10–60 mA), it is possible to obtain the pupillary pain index (PPI), a score that assesses the level of analgesia. Objectives The depth of analgesia during opioid-sparing anesthesia (OSA) with continuous infusion of dexmedetomidine in addition to general anesthesia was assessed. Design Observational prospective feasibility pilot study Setting This study was performed in the operating rooms of the Spedali Civili University-affiliated hospital of Brescia, Italy. Patients Forty-five adults who underwent elective open (5-cm incision) surgery under general anesthesia (78% inhalation anesthesia), from Feb. 18th to Aug. 1st, 2019, were enrolled. Exclusion criteria were as follows: implanted pacemaker or ICD, ophthalmological comorbidities, chronic opioid use, peripheral neuropathy, other adjuvant drugs, epidural analgesia, or locoregional block. Main outcome measures The first aim was to verify the feasibility of applying a study protocol to evaluate the depth of analgesia during intraoperative dexmedetomidine administration using an instrumental pupillary evaluation. The secondary outcome was to evaluate appropriate analgesia, drug dosage, anesthesia depth, heart rate, blood pressure, transient side effects, postoperative nausea and vomiting (PONV), and pain numerical rating scale (NRS) score. Results Thirty out of 50 patients (60%) treated with dexmedetomidine during the study period were included in the DEX group (8 males, age 42 ± 13 years, BMI 45 ± 8), and 15 other patients were included in the N-DEX group (8 males, age 62 ± 13 years, BMI 26 ± 6). Patients who underwent bariatric, abdominal, or plastic surgery were enrolled. At least 3 pupillary evaluations were taken for each patient. PPI ≤ 3 was observed in 97% of patients in the DEX group and 53% in the N-DEX group. Additionally, the DEX group received less than half the remifentanil dose than the N-DEX group (0.13 ± 0.07 vs 0.3 ± 0.11 mcg kg−1 min−1). The average dose of dexmedetomidine administered was 0.17 ± 0.08 mcg kg−1 h−1. Conclusion The feasibility of applying the protocol was verified. An OSA strategy involving dexmedetomidine may be associated with improved analgesic stability: a randomized controlled trial is necessary to verify this hypothesis. Trial registration Trial.gov registration number: NCT05785273

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Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

Cited by 7 publications

References 27 publications

Balanced Nonopioid General Anesthesia With Lidocaine Is Associated With Lower Postoperative Complications Compared With Balanced Opioid General Anesthesia With Sufentanil for Cardiac Surgery With Cardiopulmonary Bypass: A Propensity Matched Cohort Study

Balanced Nonopioid General Anesthesia With Lidocaine Is Associated With Lower Postoperative Complications Compared With Balanced Opioid General Anesthesia With Sufentanil for Cardiac Surgery With Cardiopulmonary Bypass: A Propensity Matched Cohort Study

Nociception Control of Bilateral Single-Shot Erector Spinae Plane Block Compared to No Block in Open Heart Surgery—A Post Hoc Analysis of the NESP Randomized Controlled Clinical Trial

Feasibility of the pupillary pain index as a guide for depth of analgesia during opioid-sparing anesthesia with continuous infusion of dexmedetomidine

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