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Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Bornemann-Cimenti, H; Lang-Illievich, K; Kovalevska, K; Brenna, CTA; Klivinyi, C.
Effect of nociception level index-guided intra-operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta-analysis.
Anaesthesia. 2023; 78(12): 1493-1501.
Doi: 10.1111/anae.16148
Web of Science
PubMed
FullText
FullText_MUG
- Leading authors Med Uni Graz
- Bornemann-Cimenti Helmar
- Klivinyi Christoph
- Lang-Illievich Kordula
- Co-authors Med Uni Graz
- Kovalevska Kateryna
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- Abstract:
- Acute postoperative pain remains a critical treatment priority and has prompted a search for technologies and techniques to assist with intra-operative analgesic monitoring and management. Anaesthetists traditionally rely on clinical judgement to guide intra-operative analgesia, but several emerging technologies such as the nociception level index herald the possibility of routine intra-operative analgesia monitoring. However, the impact of devices like nociception level index on postoperative outcomes has not been proven. We undertook a systematic review and meta-analysis of articles which compared nociception level index-guided analgesia to standard care. The primary outcomes were pain intensity and opioid consumption during the first 60-120 min after surgery. Secondary outcomes were the incidence of postoperative nausea and vomiting and duration of stay in the post-anaesthesia care unit. Ten studies, collectively including 662 patients and published between 2019 and 2023, met inclusion criteria for both the qualitative systematic review and quantitative meta-analysis. Risk of methodological bias was generally low or unclear, and six studies reported a significant conflict of interest relevant to their findings. Our meta-analysis was performed using a random-effects model. It found statistically significant benefits of nociception level index-guided analgesia for early postoperative pain (mean (95%CI) difference -0.46 (-0.88 to -0.03) on an 11-point scale, p = 0.03), and opioid requirement (mean (95%CI) difference -1.04 (-1.94 to -0.15) mg intravenous morphine equivalent, p = 0.02). Our meta-analysis of the current literature finds that nociception level index-guided analgesia statistically significantly reduces reported postoperative pain intensity and opioid consumption but fails to show clinically relevant outcomes. We found no evidence that nociception level index-guided analgesia affected postoperative nausea and vomiting nor duration of stay in the post-anaesthesia care unit.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Analgesics, Opioid - administration & dosage
- Postoperative Nausea and Vomiting - drug therapy
- Nociception - administration & dosage
- Analgesia - methods
- Pain, Postoperative - drug therapy
- Find related publications in this database (Keywords)
- guided analgesia
- intra-operative monitoring
- nociception level index
- NOL
- postoperative pain