PE of the EEG shows promise as a simple measure of GABAergic anaesthetic drug effect.

While buprenorphine's analgesic effect increased significantly, respiratory depression was similar in magnitude and timing for the two doses tested. We conclude that over the dose range tested buprenorphine displays ceiling in respiratory effect but none in analgesic effect.

Our data confirm a ceiling effect of buprenorphine but not fentanyl with respect to respiratory depression.

Supplemental Digital Content is Available in the Text.This experimental highly controlled trial in 20 patients with fibromyalgia shows that the cannabinoid THC, but not CBD, is effective in the treatment of fibromyalgia pain.

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.