Dundar Nurseda, Kus Alparslan, Gurkan Yavuz, Toker Kamil, Solak Mine
Department of Anesthesiology and Reanimation, School of Medicine, Kocaeli University, Kocaeli, Turkey.
Department of Anesthesiology and Reanimation, School of Medicine, Bahçeşehir University, Istanbul, Turkey.
J Clin Monit Comput. 2018 Jun;32(3):481-486. doi: 10.1007/s10877-017-0036-9. Epub 2017 Jun 19.
The goal of the study was to evaluate the effectiveness of analgesia nociception index (ANI) monitoring during intraoperative period for patients with thoracic paravertebral block (TPVB) undergoing breast surgery under general anesthesia. This prospective randomized trial was performed after receiving ethics committee approval in 44 patients who were scheduled to undergo breast surgery under general anesthesia. TPVB was performed in the preoperative period using 20 mL of bupivacaine 0.25% at T4 level. Anesthesia maintenance was provided with sevoflurane in O: air mixture and remifentanil infusion. Intraoperative concentration of sevoflurane was adjusted according to BIS monitoring keeping the values between 40-60. In a randomized manner patients were divided into two groups. In Group control (n:22) intraoperative remifentanil infusion rate was regulated according to hemodynamic parameters, in Group ANI (n:22) remifentanil infusion rate was titrated to keep ANI monitoring values between 50-70. Total remifentanil consumption was recorded as micrograms. Demographic data, anesthesia and surgery time, intraoperative hemodynamic parameters, post-anesthesia recovery time and requirement of additional analgesic in the recovery drug were recorded. There were no significant difference in demographic data, intraoperative hemodynamic parameters, post-anesthesia recovery time and requirement of additional analgesic drug. There was a statistically significant difference between groups in total remifentanil consumption (Group ANI: 629.6 ± 422.4 mcg, Group control: 965.2 ± 543.6 mcg) (p = 0.027). In patients under general anesthesia ANI monitorisation can help optimisation of opioid consumption and provide data about nociception/antinociception intraoperatively but further experimental and clinical trials in a large scale are needed.
本研究的目的是评估在全身麻醉下接受乳房手术的胸段椎旁阻滞（TPVB）患者术中镇痛伤害感受指数（ANI）监测的有效性。这项前瞻性随机试验在获得伦理委员会批准后，对44例计划在全身麻醉下接受乳房手术的患者进行。术前在T4水平使用20毫升0.25%布比卡因进行TPVB。采用七氟醚与氧气/空气混合气体及瑞芬太尼输注维持麻醉。根据脑电双频指数（BIS）监测调整术中七氟醚浓度，使其值保持在40 - 60之间。患者以随机方式分为两组。对照组（n = 22）术中瑞芬太尼输注速率根据血流动力学参数进行调节，ANI组（n = 22）瑞芬太尼输注速率滴定至使ANI监测值保持在50 - 70之间。瑞芬太尼总消耗量记录为微克。记录人口统计学数据、麻醉和手术时间、术中血流动力学参数、麻醉后恢复时间以及恢复期间额外镇痛药的需求。人口统计学数据、术中血流动力学参数、麻醉后恢复时间和额外镇痛药需求方面无显著差异。两组之间瑞芬太尼总消耗量存在统计学显著差异（ANI组：629.6±422.4微克，对照组：965.2±543.6微克）（p = 0.027）。在全身麻醉患者中，ANI监测有助于优化阿片类药物的使用，并提供术中伤害感受/抗伤害感受的数据，但需要进一步开展大规模的实验和临床试验。
