Intraoperative monitoring of nociception for opioid administration: a meta-analysis of randomized controlled trials

Jiao, Yang; He, Bin; Tong, Xingyu; Ran, Xia; Zhang, Chengmi; Shi, Xueyin

doi:10.23736/s0375-9393.19.13151-3

Cited by 60 publications

(54 citation statements)

References 31 publications

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“…The surgical pleth index (SPI), initially named the surgical stress index (SSI), is calculated from the heartbeat interval (HBI) and pulse photoplethysmographic amplitude (PPGA) for titration of anesthetic doses, and re ects the degree of intraoperative analgesia/nociception on a scale from 0 (complete analgesia) to (maximal nociception) [9]. The effectiveness of SPI for quantifying analgesia/nociception during general anesthesia has been demonstrated in many clinical settings, con rming its reliability as an analgesia-monitoring method [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Utilization of Pleth Index in Hysteroscopic Surgery: A Randomized Controlled Trial

Yao

Huang

Zheng

et al. 2020

Preprint

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Background: When performing hysteroscopic surgery under general anesthesia in non-intubated patients, anesthesiologists and gynecologists face challenges including patient movement and respiratory depression due to variability in the depth of patient anesthesia. Intraoperative modulation of the depth of anesthesia is dictated by clinical practice. In recent years, the noninvasive surgical pleth index (SPI) has been purported to objectively reflect the depth of anesthesia. In the present study, we investigated the performance of SPI monitoring in hysteroscopic surgery.Methods: Eighty patients scheduled for hysteroscopic surgery under general anesthesia with a laryngeal mask airway (i.e., spontaneous ventilation without a muscle relaxant) were randomly divided into two groups (both n = 40): (1) bispectral index (BIS)- and SPI-monitoring group (BS Group); and (2) BIS-monitoring group (B group). Intraoperative analgesia was provided via target-controlled infusion (TCI) of remifentanil, which was modulated according to the SPI value (target interval, 20–50) in the BS Group or via the anesthesiologist's assessment in the B Group. In both groups, anesthesia was administered to maintain the BIS values between 40–60. Additionally, the incidences and degree of movement, consumption of anesthetic drugs, recovery times, complications, and satisfactory levels were compared between the two groups.Results: The incidence and degree of bodily movement in the BS Group were significantly lower than those in the B Group (P < 0.05). Furthermore, the remifentanil induction dose and recovery time in the BS group were significantly lower than those in the B group (P < 0.05). However, there were no significant differences between the two groups with regard to adverse events including nausea, vomiting, and dizziness. Finally, gynecologists had higher satisfactory levels in the BS Group (P < 0.05).Conclusion: SPI- and BIS-guided general anesthesia is clinically feasible in hysteroscopic surgery and leads to both inhibition of intraoperative movement and faster recovery.

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Section: Introductionmentioning

confidence: 99%

Utilization of Pleth Index in Hysteroscopic Surgery: A Randomized Controlled Trial

Yao

Huang

Zheng

et al. 2020

Preprint

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“…Thirdly, while the intraoperative doses of opioids seem to be significantly reduced by using nociception monitoring, with regard to postoperative pain intensity and relative opioid consumption, these systems did not show any advantage over standard of care. 5 therefore, i can conclude that, as attributed to albert einstein, "not everything that can be counted counts, and not everything that counts can be counted." the role of currently available devices for intraoperative nociception monitoring is still unclear, but, for adequate analgesia management during surgery, the need for an objective measurement as an alternative to the current clinical standard of care is imminent.…”

mentioning

confidence: 99%

“…4 in this issue of Minerva Anestesiologica, Jiao et al performed a meta-analysis of current available trials evaluating intraoperative nociceptive monitoring as a guide for opioid administration during surgery. 5 authors evaluated three devices: analgesia nociception index (ani; MDMs, loos, France), surgical Pleth index (sPi; ge Healthcare, Helsinki, Finland) and pupillometry.…”

mentioning

confidence: 99%

“…85 -no. 5 Minerva anestesiologica 463 ers affect the use of the r-r interval as a reliable value of sympathetic-parasympathetic balance. Moreover, the use of antimuscarinic drugs modify the assessment of the antinociception/nociception balance.…”

mentioning

confidence: 99%

“…However, the reduction of intraoperative opioid consumption was significant only during sevoflurane anesthesia. 5 in conclusion, there are still too many questions about the clinical use of these devices with the aim to give specific recommendations. Firstly, clinicians need to know the clinically relevant thresholds of each system, which consent to discriminate effective versus insufficient analgesia.…”

mentioning

confidence: 99%

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