Nociception level index: do intra-operative values allow the prediction of acute postoperative pain?

Ledowski, Thomas; Schlueter, Paul; Hall, Nyomi

doi:10.1007/s10877-021-00654-8

Cited by 15 publications

(10 citation statements)

References 18 publications

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“…The possibility of single-value postoperative pain predictions, with a longer prediction horizon, has been recently reported [ 89 ], where only low NOL index values after skin incision significantly excluded moderate-severe pain in the PACU, with a negative predictive value of 83%, while other intraoperative NOL values, including at the end of the surgery, showed no significant prediction. This result conceptually invalidates all post-incision NOL estimations, with low sensitivity to detect a potential subjacent problem from an incision event that emerges later in the PACU.…”

Section: Discussionmentioning

confidence: 99%

Different perspectives for monitoring nociception during general anesthesia

Vazquez

Jensen²

2022

Korean J Anesthesiol

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A safe anesthesia is achieved by possessing objective methods that estimate the patient's state along the different phases of the surgery. The patient's state under anesthesia is characterized by three major aspects linked to the main effects produced by each of the families of anesthetic agents administered: hypnosis, analgesia, and muscular relaxation.While muscular relaxation assessment, under neuromuscular blocking agents, has a relatively long history of quantification techniques with a high degree of standardization and understanding, such as the train-of-four, the depth of hypnosis estimation, due to the brain complexity, suffers from a lesser degree in both monitoring standardization and interpretation.The problem of analgesia and nociception monitoring standardization and interpretation increases significantly since more systems get involved, the central nervous system and the autonomic system, which illustrates why currently, there are multiple a priori valid approaches to develop the nociception monitoring from different interpretations and physiological bases of the noxious stimuli processing.This review describes the main current monitoring technologies available in the daily clinic for estimating the patient's nociception under general anesthesia.

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Section: Discussionmentioning

confidence: 99%

Different perspectives for monitoring nociception during general anesthesia

Vazquez

Jensen²

2022

Korean J Anesthesiol

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“…lww.com/AA/E173). Further, there was no significant difference between NOL and routine care on time to emergence from anesthesia, with median [quartiles] minutes of 18 [16,22] and 20 [18,22] and estimated hazard ratio (95% CI) of 1.01 (0.63-1.63), P = .967 (Supplemental Digital Content 1, Supplemental Table 5, http://links.lww.com/AA/E173).…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Nociception Level Index–Guided Intraoperative Analgesia for Improved Postoperative Recovery: A Randomized Trial

Ruetzler¹,

Montalvo²,

Bakal³

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Nociception is the physiological response to nociceptive stimuli, normally experienced as pain. During general anesthesia, patients experience and respond to nociceptive stimuli by increasing blood pressure and heart rate if not controlled by preemptive analgesia. The PMD-200 system from Medasense (Ramat Gan, Israel) evaluates the balance between nociceptive stimuli and analgesia during general anesthesia and generates the nociception level (NOL) index from a single finger probe. NOL is a unitless index ranging from 0 to 100, with values exceeding 25 indicating that nociception exceeds analgesia. We aimed to demonstrate that titrating intraoperative opioid administration to keep NOL <25 optimizes intraoperative opioid dosing. Specifically, we tested the hypothesis that pain scores during the initial 60 minutes of recovery are lower in patients managed with NOL-guided fentanyl than in patients given fentanyl per clinical routine. METHODS: We conducted a randomized, single-center trial of patients having major abdominal open and laparoscopic surgeries. Patients were randomly assigned 1:1 to intraoperative NOLguided fentanyl administration or fentanyl given per clinical routine. The primary outcome was pain score (0-10 verbal response scale) at 10-minute intervals during the initial 60 minutes of recovery. Our secondary outcome was a measure of adequate analgesia, defined as a pain score <5, assessed separately at each interval. RESULTS: With a planned maximum sample size of 144, the study was stopped for futility after enrolling 72 patients from November 2020 to October 2021. Thirty-five patients were assigned to NOL-guided analgesic dosing and 37 to routine care. Patients in the NOL group spent significantly less time with a NOL index >25 (median reduction [95% confidence interval {CI}] of 14 [4-25] minutes) were given nearly twice as much intraoperative fentanyl (median [quartiles] 500 [330, 780] vs 300 [200, 330] µg), and required about half as much morphine in the recovery period (3.3 [0, 8] vs 7.7 [0, 13] mg). However, in the primary outcome analysis, NOL did not reduce pain scores in the first 60 minutes after awakening, assessed in a linear mixed effects model with mean (standard error [SE]) of 4.12 (0.59) for NOL and 4.04 (0.58) for routine care, and estimated difference in means of 0.08 (−1.43, 1.58), P = .895. CONCLUSIONS: More intraoperative fentanyl was given in NOL-guided patients, but NOL guidance did not reduce initial postoperative pain scores. (Anesth Analg 2023;136:761-71) KEY POINTS• Question: Does guiding intraoperative opioid administration to nociception level (NOL, PMD-200 system from Medasense) improve initial pain recovery characteristics in the postanesthesia care unit (PACU)? • Findings: In this randomized trial with 72 patients, patients in the NOL group were given nearly twice as much intraoperative fentanyl and required about half as much morphine during the initial 60 minutes of recovery, but pain scores did not differ between groups. • Meaning: Under the circumstanc...

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“…Similarly, a NoL-driven analgesia (target < 10 after the surgery begins) showed a negative predictive value of 83% for preventing severe postoperative pain [ 75 ] and resulted in lower postoperative pain although similar opioid consumption in adults [ 76 ].…”

Section: Prediction Of Postoperative Painmentioning

confidence: 99%

Evaluation of Nociception during Pediatric Surgery: A Topical Review

Bertolizio

Garbin

Ingelmo

2023

JPM

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The association between intraoperative nociception and increased patient’s morbidity is well established. However, hemodynamic parameters, such as heart rate and blood pressure, may result in an inadequate monitor of nociception during surgery. Over the last two decades, different devices have been marketed to “reliably” detect intraoperative nociception. Since the direct measure of nociception is impractical during surgery, these monitors measures nociception surrogates such as sympathetic and parasympathetic nervous systems responses (heart rate variability, pupillometry, skin conductance), electroencephalographic changes, and muscular reflex arc. Each monitor carries its own advantages and disadvantages. The manuscript aims to give an overview of the most up-to-date information available in the literature on current nociceptor monitors available in clinical practice, with particular focus on their applications in pediatrics.

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Nociception level index: do intra-operative values allow the prediction of acute postoperative pain?

Cited by 15 publications

References 18 publications

Different perspectives for monitoring nociception during general anesthesia

Different perspectives for monitoring nociception during general anesthesia

Nociception Level Index–Guided Intraoperative Analgesia for Improved Postoperative Recovery: A Randomized Trial

Evaluation of Nociception during Pediatric Surgery: A Topical Review

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