Reduced postoperative pain using Nociception Level-guided fentanyl dosing during sevoflurane anaesthesia: a randomised controlled trial

Abstract

Background: The majority of postoperative patients report moderate to severe pain, possibly related to opioid underdosing or overdosing during surgery. Objective guidance of opioid dosing using the Nociception Level (NOL) index, a multiparameter artificial intelligence-driven index designed to monitor nociception during surgery, may lead to a more appropriate analgesic regimen, with effects beyond surgery. We tested whether NOL-guided opioid dosing during general anaesthesia results in less postoperative pain. Methods: In this two-centre RCT, 50 patients undergoing abdominal surgery under fentanyl/sevoflurane anaesthesia were randomised to NOL-guided fentanyl dosing or standard care in which fentanyl dosing was based on haemodynamics. The primary endpoint of the study was postoperative pain assessed in the PACU. Results: Median postoperative pain scores were 3.2 (inter-quartile range 1.3e4.3) and 4.8 (3.0e5.3) in NOL-guided and standard care groups, respectively (P¼0.006). Postoperative morphine consumption (standard deviation) was 0.06 (0.07) mg kg À1 (NOL-guided group) and 0.09 (0.09) mg kg À1 (control group; P¼0.204). During surgery, fentanyl dosing was not different between groups (NOL-guided group: 6.4 [4.2] mg kg À1 vs standard care: 6.0 [2.2] mg kg À1 , P¼0.749), although the variation between patients was greater in the NOL-guided group (% coefficient of variation 66% in the NOL-guided group vs 37% in the standard care group). Conclusions: Despite absence of differences in fentanyl and morphine consumption during and after surgery, a 1.6-point improvement in postoperative pain scores was observed in the NOL-guided group. We attribute this to NOL-driven rather than BP-and HR-driven fentanyl dosing during anaesthesia. Clinical trial registration: www.trialregister.nl under identifier NL7845.

Technology, engineering and innovations- Power buffers in the COVID driveline.....

“…[ 6 ] Randomised controlled trials on the use of NOL index-guided opioid dosing during general anaesthesia for reduction in postoperative pain have been conducted and some more studies on this topic are currently underway. [ 7 ] Although research work on target controlled infusion (TCI) including work on the pharmacokinetic and pharmacodynamic fronts of TCI, intraoperative ANI, non-invasive cardiac output measurement and NOL index, has been done, more research work in these areas by Indian researchers is the need of the hour. [ 8 9 10 ]…”

Artificial intelligence in perioperative management of major gastrointestinal surgeries

“…Postoperative pain after abdominal surgeries was studied in a randomized controlled trial (RCT) involving 50 patients using the Nociception Level (NOL) index, a multiparameter AI-driven index designed to monitor nociception during surgery. That study found no differences in perioperative opioid (fentanyl and morphine) consumption, but there was a 1.6-point improvement in postoperative pain scores in the NOL-guided group[ 84 ] (Figure 3 ).…”

Effect of surgical pleth index-guided analgesia versus conventional analgesia techniques on fentanyl consumption under multimodal analgesia in laparoscopic cholecystectomy: a prospective, randomized and controlled study

“…To date, several monitoring solutions have been commercialized, such as single-parameter scores (analgesia nociception index, skin conductance, pupillometry, nociceptive flexion reflex threshold), two-parameter scores (Surgical Pleth Index and qNOX) and multiparameter scores (nociception level index) [7,8]. The surgical Pleth Index (SPI) has attracted considerable attention for its role in guiding the use of intraoperative opioids and predicting postoperative acute pain.…”