Comparison between Analgesia Nociception Index (ANI) and self-reported measures for diagnosing pain in conscious individuals: a systematic review and meta-analysis

Daniela Abrão Baroni,Luciane Rezende Costa,Saul Martins Paiva,Lucas Guimarães Abreu

doi:10.1038/s41598-022-06993-z

Daniela Abrão Baroni, Luciane Rezende Costa + Show 2 more

Open Access

https://doi.org/10.1038/s41598-022-06993-z

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Abstract

The Analgesia Nociception Index (ANI), an objective measure of pain based on heart rate variability (HRV), has its usefulness in awake patients still unclear. This systematic review and meta-analysis aimed to assess ANI's accuracy compared to self-reported pain measures in conscious individuals undergoing medical procedures or painful stimuli. PubMed, Ovid, Web of Science, Scopus, Embase, and grey literature were searched until March 2021. Of the 832 identified citations, 16 studies complied with the eligibility criteria. A meta-analysis including nine studies demonstrated a weak negative correlation between ANI and NRS for pain assessment in individuals in the post-anesthetic recovery room (r = − 0.0984, 95% CI = − 0.397 to 0.220, I2 = 95.82%), or in those submitted to electrical stimulus (r = − 0.089; 95% CI = − 0.390 to 0.228, I2 = 0%). The evidence to use ANI in conscious individuals is weak compared to self-report measures of pain, yet ANI explains a part of self-report. Therefore, some individuals may be benefited from the use of ANI during procedures or in the immediate postoperative period.

Highlights

The reliability of an instrument, test, or exam relies on its accuracy compared to the ’gold standard’ for diagnosing a condition or disease
Given that there is no standardisation in clinical references in the literature, this systematic review and meta-analysis aimed to compare Analgesia Nociception Index (ANI) and self-reported measures for diagnosing pain in conscious individuals undergoing medical procedures or painful stimuli
ANI performed well to detect moderate to severe pain upon arrival in the Post-Anaesthesia Care Unit (PACU), which was improved with propofol-based (AUC = 0.93) in comparison with halogenated-based anaesthesiaUC = 0.82)[30]

Summary

Introduction

The reliability of an instrument, test, or exam relies on its accuracy compared to the ’gold standard’ for diagnosing a condition or disease. It is not different when pain is assessed. Assessments of nociception combined with the best pain control strategy (analgesia) have encouraged studies with instruments that can evaluate pain objectively[5]. In this perspective, the Analgesia Nociception Index (ANI, PhysiodolorisTM; Metrodoloris, France) is a non-invasive tool placed on the market in the last decade. Given that there is no standardisation in clinical references in the literature, this systematic review and meta-analysis aimed to compare ANI and self-reported measures for diagnosing pain in conscious individuals undergoing medical procedures or painful stimuli

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