Identification of the intraoperative antinociceptive effect of intravenous fentanyl using the Nociception Level (NOL) index versus clinical parameters in patients undergoing gynecological laparoscopic surgery: A secondary analysis of the NOLGYN study.
Fentanyl
General anaesthesia
Nociception
Pain monitoring
Journal
Anaesthesia, critical care & pain medicine
ISSN: 2352-5568
Titre abrégé: Anaesth Crit Care Pain Med
Pays: France
ID NLM: 101652401
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
received:
25
01
2022
revised:
26
03
2022
accepted:
02
04
2022
pubmed:
2
6
2022
medline:
2
8
2022
entrez:
1
6
2022
Statut:
ppublish
Résumé
While we typically assess nociception balance during general anesthesia through clinical parameters such as heart rate (HR) and mean arterial pressure (MAP) variation, these parameters are not specific to nociception. We hypothesized that using the Nociception Level (NOL) index to assess the analgesic effect of a fentanyl bolus would be superior to standard clinical parameters. Ancillary study of the NOLGYN study, a randomized controlled trial comparing intraoperative NOL-guided administration of fentanyl (NOL group) versus standardized care (SC group). University hospital in Montréal, Canada between November 2018, and December 2019. Women undergoing gynecological laparoscopic surgery. In our evaluation of intraoperative nociception, we analyzed the analgesic effect of fentanyl using three parameters: MAP, HR, and the Nociception Level (NOL) index. All fentanyl injection events were extracted from the database. The primary endpoint was the difference between values before and after each injection. The median of the NOL index before fentanyl injection was 30.5 (IQR 19.4 to 40.7) versus 18.9 (IQR 11.5 to 27.4) after (P < 0.001). The median of MAP was 106.4 mmHg (IQR 99.9 to 113.4) before injection versus 103.2 mmHg (IQR 97.5-110.7) after (P < 0.001). The median of HR before injection was 74.2 (IQR 64.2-83.8) versus 72.4 (IQR 63.4-81.3) after (P < 0.001). The NOL index, HR, and MAP all statistically discriminated the analgesic effect of fentanyl but only the NOL index proved clinically relevant to identify the analgesic effect of one fentanyl injection. www. gov (NCT03776838) registered in October 2018.
Sections du résumé
BACKGROUND
While we typically assess nociception balance during general anesthesia through clinical parameters such as heart rate (HR) and mean arterial pressure (MAP) variation, these parameters are not specific to nociception.
OBJECTIVE
We hypothesized that using the Nociception Level (NOL) index to assess the analgesic effect of a fentanyl bolus would be superior to standard clinical parameters.
DESIGN
Ancillary study of the NOLGYN study, a randomized controlled trial comparing intraoperative NOL-guided administration of fentanyl (NOL group) versus standardized care (SC group).
SETTING
University hospital in Montréal, Canada between November 2018, and December 2019.
PATIENTS
Women undergoing gynecological laparoscopic surgery.
INTERVENTION
In our evaluation of intraoperative nociception, we analyzed the analgesic effect of fentanyl using three parameters: MAP, HR, and the Nociception Level (NOL) index. All fentanyl injection events were extracted from the database.
MAIN OUTCOME MEASURE
The primary endpoint was the difference between values before and after each injection.
RESULTS
The median of the NOL index before fentanyl injection was 30.5 (IQR 19.4 to 40.7) versus 18.9 (IQR 11.5 to 27.4) after (P < 0.001). The median of MAP was 106.4 mmHg (IQR 99.9 to 113.4) before injection versus 103.2 mmHg (IQR 97.5-110.7) after (P < 0.001). The median of HR before injection was 74.2 (IQR 64.2-83.8) versus 72.4 (IQR 63.4-81.3) after (P < 0.001).
CONCLUSIONS
The NOL index, HR, and MAP all statistically discriminated the analgesic effect of fentanyl but only the NOL index proved clinically relevant to identify the analgesic effect of one fentanyl injection.
TRIAL REGISTRATION
www.
CLINICALTRIALS
gov (NCT03776838) registered in October 2018.
Identifiants
pubmed: 35643392
pii: S2352-5568(22)00083-2
doi: 10.1016/j.accpm.2022.101102
pii:
doi:
Substances chimiques
Analgesics, Opioid
0
Fentanyl
UF599785JZ
Banques de données
ClinicalTrials.gov
['NCT03776838']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
101102Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.