Reduced postoperative pain using Nociception Level-guided fentanyl dosing during sevoflurane anaesthesia: a randomised controlled trial

British Journal of Anaesthesia, vol. 125, pp. 1070–1078

Abstract

Background The majority of postoperative patients report moderate to severe pain, possibly related to opioid underdosing or overdosing during surgery. Objective guidance of opioid dosing using the Nociception Level (NOL) index, a multiparameter artificial intelligence-driven index designed to monitor nociception during surgery, may lead to a more appropriate analgesic regimen, with effects beyond surgery. We tested whether NOL-guided opioid dosing during general anaesthesia results in less postoperative pain. Methods In this two-centre RCT, 50 patients undergoing abdominal surgery under fentanyl/sevoflurane anaesthesia were randomised to NOL-guided fentanyl dosing or standard care in which fentanyl dosing was based on haemodynamics. The primary endpoint of the study was postoperative pain assessed in the PACU. Results Median postoperative pain scores were 3.2 (inter-quartile range 1.3–4.3) and 4.8 (3.0–5.3) in NOL-guided and standard care groups, respectively ( P =0.006). Postoperative morphine consumption (standard deviation) was 0.06 (0.07) mg kg −1 (NOL-guided group) and 0.09 (0.09) mg kg −1 (control group; P =0.204). During surgery, fentanyl dosing was not different between groups (NOL-guided group: 6.4 [4.2] μg kg −1 vs standard care: 6.0 [2.2] μg kg −1 , P =0.749), although the variation between patients was greater in the NOL-guided group (% coefficient of variation 66% in the NOL-guided group vs 37% in the standard care group). Conclusions Despite absence of differences in fentanyl and morphine consumption during and after surgery, a 1.6-point improvement in postoperative pain scores was observed in the NOL-guided group. We attribute this to NOL-driven rather than BP- and HR-driven fentanyl dosing during anaesthesia. Clinical trial registration www.trialregister.nl under identifier NL7845.

Authors 11

1. Fleur Meijer Aachen Department of Anesthesiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands

2. Tessa Roor Aachen Department of Anesthesiology, Alrijne Hospital Department of Anesthesiology, Leiden University Medical Center

   Leiden University Medical Center · Alrijne Ziekenhuis

   Affiliation as printed

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands; Department of Anesthesiology, Alrijne Hospital, Leiderdorp, Netherlands

   Department of Anesthesiology, Alrijne Hospital, Leiderdorp, Netherlands

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands

3. Samantha Toet Aachen Department of Anesthesiology, Alrijne Hospital Department of Anesthesiology, Leiden University Medical Center

   Leiden University Medical Center · Alrijne Ziekenhuis

   Affiliation as printed

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands; Department of Anesthesiology, Alrijne Hospital, Leiderdorp, Netherlands

   Department of Anesthesiology, Alrijne Hospital, Leiderdorp, Netherlands

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands

4. Paul Calis Aachen Department of Anesthesiology, Alrijne Hospital

   Alrijne Ziekenhuis

   Affiliation as printed

   Department of Anesthesiology, Alrijne Hospital, Leiderdorp, Netherlands

5. Erik Olofsen Aachen Department of Anesthesiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands

6. Chris H. Martini Aachen Department of Anesthesiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands

7. Monique van Velzen Aachen Department of Anesthesiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands

8. Leon P.H.J. Aarts Aachen Department of Anesthesiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands

9. Marieke Niesters Aachen Department of Anesthesiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands

10. Martijn Boon Aachen Department of Anesthesiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands

11. Albert Dahan corresponding Aachen Department of Anesthesiology, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands. Electronic address: a.dahan@lumc.nl

    Department of Anesthesiology, Leiden University Medical Center, Leiden, Netherlands