Utility of nociceptive flexion reflex threshold and bispectral index to predict movement responses under propofol anaesthesia

Jakuscheit, Axel; Posch, Matthias; Gkaitatzis, Stefanos; Neumark, Lisa; Hackbarth, Mark; Schneider, Mark; Lichtner, Gregor; Baars, Jan H.; Dincklage, Falk von

doi:10.1080/08990220.2017.1343189

Cited by 18 publications

(18 citation statements)

References 29 publications

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“…53 This threshold may increase with increased levels of analgesia, and has been found to be able to predict sudden movement as a result of a noxious stimulus. 54 However, although in this study by Jakuscheit and colleagues, 54 NFTS had some predictive probability (0.63 [95% confidence interval {CI}: 0.59e0.67]); this was relatively low (predictive probability of 0.5¼tossing a coin) and lower than that of the bispectral index. Measured at the end of surgery, just before tracheal extubation, the NFTS also showed some limited predictive value for postoperative pain in PACU.…”

Section: Nfr Threshold (Nfts Paintracker; Dolosys Berlin Germany)mentioning

confidence: 59%

Objective monitoring of nociception: a review of current commercial solutions

Ledowski

2019

British Journal of Anaesthesia

170

141

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Nociception, in contrast to pain, is not a subjective feeling, but the physiological encoding and processing of nociceptive stimuli. However, monitoring nociception remains a challenge in attempts to lower the incidence of acute postoperative pain and the move towards a more automated approach to analgesia and anaesthesia. To date, several commercialised devices promise a more accurate reflection of nociception than the traditionally used vital signs, blood pressure and heart rate. This narrative review presents an overview of existing technologies and commercially available devices, and offers a perspective for future research. Although firm conclusions about individual methods may be premature, none currently appears to offer a sufficiently broad applicability. Furthermore, there is currently no firm evidence for any clinically relevant influence of such devices on patient outcome. However, the available monitors have significantly aided the understanding of underlying mechanisms and identification of potential pitfalls.

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Section: Nfr Threshold (Nfts Paintracker; Dolosys Berlin Germany)mentioning

confidence: 59%

Objective monitoring of nociception: a review of current commercial solutions

Ledowski

2019

British Journal of Anaesthesia

170

141

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“…In the present study, patients with RASS scores of -5 had more than twice as high NFRTs compared with patients with RASS scores of -4 and higher. From a purely objective point of view, if the stimulus threshold > 20 mA assumed as adequate analgesia in the literature is taken into account, these deeply sedated patients can be considered to exhibit overanalgesia (11,14,18,19). In the interpretation of these results, however, it must be taken into account that ultimately only nociception is recorded.…”

Section: Discussionmentioning

confidence: 99%

“…To address the limitations of pain assessment in critically ill non-communicable patients, measurement of the RIII-re ex threshold of the nociceptive exor re ex (NFR) is of particular interest. Under general anesthesia, measurement of the NFR-threshold (NFRT) has been shown to correlate negatively with the response rate to a painful stimulus (11)(12)(13)(14). An equally important aspect in the context of pain assessment in critically ill patients is the quanti cation of adequate and appropriate analgesia.…”

Section: Introductionmentioning

confidence: 99%

Measurement of the nociceptive flexion reflex threshold in critically ill patients - a monocentric prospective observational study

Schick

Mayer

Walter

et al. 2021

Preprint

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Background Pain detection and treatment is a major challenge in the care of critically ill patients. However, in addition to the risk of analgesic undersupply, there is also the risk of overanalgesia. In the perioperative context, the measurement of the nociceptive flexion reflex threshold has become established for measuring the level of analgesia. To date, however, it is unclear whether measurement of NFRT can be usefully applied to noncommunicating, ventilated, and analgosedated ICU patients. Therefore, the aim of the present study was to investigate whether NFRT measurement correlates with the Behavioral Pain Scale (BPS) in critically ill, analgosedated, and mechanically ventilated patients and whether it can also detect possible overanalgesia.Methods In this prospective, observational, single-center study, 114 patients were included. All patients were admitted to the surgical Intensive Care Unit of the University hospital Ulm, Germany. First measurements of the NFRT and the Behavioral Pain Scale (BPS) were conducted within 12 hours after admission. In the further observation period, a structured pain assessment was performed at least twice daily until extubation (Group A: BPS + NFRT, Group B: BPS). Univariate analysis was performed to evaluate possible associations between NFRT measurement and baseline characteristics. Furthermore, mixed linear regression modeling was used to evaluate possible effects of administered analgesics or sedatives on NFRT. Results NFRT correlates negatively with the Behavioral Pain Scale. NFRT was almost twice as high in patients with a RASS of -5 compared with patients with a RASS ≥ -4 (RASS -5 - NFRT: 59.40 vs. RASS -4 - NFRT: 29.00, p < 0.001). By means of NFRT measurement, potential overanalgesia could not be detected.Conclusion The NFRT measurement reliably correlates negatively with the Behavioral Pain Scale in critically ill patients. In patients with RASS scores ≤ -4, in whom analgesia level is often difficult to assess, NFRT measurement provides guidance in the assessment of nociceptive processes. However, in order to detect possible overanalgesia and to derive therapeutic consequences, a defined stimulus threshold must be determined for the critically ill patient, above which the absence of pain can be safely assumed.Trial Registration Retrospectively registered at German Clinical Trials Register, registration number DRKS00021149, date of registration: March 26, 2020. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021149

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“…BIS can well reflect the depth of sedation of anesthetic drugs and is an accurate and sensitive index to evaluate the effect of anesthesia [ 23 ]. A study of 140 cardiac surgery patients under propofol during their postoperative phase reported that although it does not reflect the physiological structures of movement suppression, allows an even more accurate prediction due to its ability to closely correlate with the dose of propofol administered [ 24 ]. The BIS index is positively correlated with OAA/S scale.…”

Section: Discussionmentioning

confidence: 99%

Relationship betweenUGT1A9gene polymorphisms, efficacy, and safety of propofol in induced abortions amongst Chinese population: a population-based study

et al. 2017

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The present study aimed to investigate the influence of UGT1A9 gene polymorphisms on the efficacy of propofol in patients undergoing the painless induced abortion method. A total of 156 women seeking voluntary pregnancy termination procedures were selected for the study, and subsequently underwent painless induced abortions, following anesthesia by means of propofol administration. PCR-restriction fragment length polymorphism (PCR-RFLP) was performed to detect the polymorphisms of UGT1A9 gene at –440C/T, –1818C/T, and –1887T/G loci. The time, effect-site concentration, and bispectral index (BIS) for the Observer’s Assessment of Alertness/Sedation (OAA/S) (up to 4 points) were observed and recorded in patients following discontinuation of propofol. The time and effect-site concentration for BIS reaching 80 in patients following the discontinuation of propofol were observed and recorded. Postoperative observations of adverse reactions, such as nausea, vomiting, and respiratory depression were all made record of. In comparison with patients with UGT1A9 –440C/T CT and TT, those with UGT1A9 –440C/T CC displayed shorter durations of OAA/S by up to 4 points, shorter BIS times reaching 80, as well as higher corresponding effect-site concentrations. No significant differences were detected in the patients with –440C/T, –1818T/C, and –1887T/G in incidence of nausea, vomiting, and respiratory depression. The findings of the study highlighted correlation between UGT1A9 –440C/T gene polymorphisms and positive propofol efficacy in patients undergoing painless induced pregnancy termination procedures.

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Utility of nociceptive flexion reflex threshold and bispectral index to predict movement responses under propofol anaesthesia

Abstract: German clinical trial register (DRKS00003062, Deutsches Register Klinischer Studien).

Cited by 18 publications

References 29 publications

Objective monitoring of nociception: a review of current commercial solutions

Objective monitoring of nociception: a review of current commercial solutions

Measurement of the nociceptive flexion reflex threshold in critically ill patients - a monocentric prospective observational study

Relationship betweenUGT1A9gene polymorphisms, efficacy, and safety of propofol in induced abortions amongst Chinese population: a population-based study

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