Abstract
The clinical benefits to be expected from intraoperative nociception monitors are currently under investigation. Among these devices, the Analgesia Nociception-Index (ANI) has shown promising results under sevoflurane anesthesia. Our study investigated ANI-guided remifentanil administration under propofol anesthesia. We hypothesized that ANI guidance would result in reduced remifentanil consumption compared with standard management. This prospective, randomized, controlled, single-blinded, bi-centric study included women undergoing elective gynecologic surgery under target-controlled infusion of propofol and remifentanil. Patients were randomly assigned to an ANI or Standard group. In the ANI group, remifentanil target concentration was adjusted by 0.5 ng mL−1 steps every 5 min according to the ANI value. In the Standard group, remifentanil was managed according to standard practice. Our primary objective was to compare remifentanil consumption between the groups. Our secondary objectives were to compare the quality of anesthesia, postoperative analgesia and the incidence of chronic pain. Eighty patients were included. Remifentanil consumption was lower in the ANI group: 4.4 (3.3; 5.7) vs. 5.8 (4.9; 7.1) µg kg−1 h−1 (difference = −1.4 (95% CI, −2.6 to −0.2), p = 0.0026). Propofol consumption was not different between the groups. Postoperative pain scores were low in both groups. There was no difference in morphine consumption 24 h after surgery. The proportion of patients reporting pain 3 months after surgery was 18.8% in the ANI group and 30.8% in the Standard group (difference = −12.0 (95% CI, −32.2 to 9.2)). ANI guidance resulted in lower remifentanil consumption compared with standard practice under propofol anesthesia. There was no difference in short- or long-term postoperative analgesia.
Highlights
We designed this prospective randomized controlled trial to assess the potential benefits of Analgesia Nociception-Index (ANI)-guided remifentanil administration in patients under propofol anesthesia
Median remifentanil consumption was lower in the ANI group: 4.4 (3.3; 5.7) vs. 5.8 (4.9; 7.1) μg kg−1 h−1 (difference = −1.4, p = 0.0026)
The proportion of patients who were “very satisfied” was higher in the ANI group: 83.3% vs. 38.5% in the Standard group
Summary
The monitoring of nociception has made substantial progress in the last decade. Several devices have been validated as monitoring tools for intraoperative nociception. Another study failed to demonstrate any advantage of ANI guidance over standard practice [10] These studies were included in a recent meta-analysis, concluding that under sevoflurane anesthesia, the difference between. There were no published data about ANI guidance of intraoperative opioids under propofol anesthesia. Propofol and sevoflurane both depress global autonomic nervous activity, but their specific effects on the sympathetic and parasympathetic components of the autonomous nervous system are different [14,15]. The ANI data obtained under sevoflurane cannot be directly extrapolated to propofol anesthesia We designed this prospective randomized controlled trial to assess the potential benefits of ANI-guided remifentanil administration in patients under propofol anesthesia. We studied postoperative morphine requirements, pain and opioid-related side-effects
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