School of Medicine and Pharmacology, University of Western Australia, Level 2 Royal Perth Hospital MRF Building, Rear 50 Murray Street, Perth, WA, 6000, Australia.
Royal Perth Hospital, Wellington St, Perth, WA, 6000, Australia.
J Clin Monit Comput. 2022 Apr;36(2):349-354. doi: 10.1007/s10877-021-00654-8. Epub 2021 Jan 24.
Nociception Level Index (NOL) guided analgesia has previously been found to correlate with noxious stimuli during surgery. It was aim of this study to investigate the relationship between intra-operative NOL and acute postoperative pain. After IRB approval, 80 patients scheduled for non-emergency surgery were enrolled. NOL data were recorded from induction of anaesthesia until the end of surgery. After admission to the postoperative acute care unit (PACU), pain scores (numeric rating scale [NRS, 0-10] were obtained 5-minutely for 15 min. NOL data of 74 patients were analyzed. Receiver-operating curve (ROC) analysis identified the NOL reaction to the knife to skin incision (median NOL within 60 s post knife to skin) vs. the median NOL during surgery vs. NOL at the end of surgery to have the highest correlation coefficient (ρ = 0.3; P = 0.01) as well as the highest area under the ROC curve (AUC 0.68; P = 0.01) for the prediction of moderate-severe pain in PACU. A NOL > 20 after skin incision predicted moderate-severe postoperative pain with the highest combined sensitivity (73%) and specificity (58%). A NOL < 10 after skin incision excluded moderate-severe pain in PACU with a negative predictive value of 83%. The NOL reaction to skin incision, but not NOL during surgery appears to allow the exclusion and, to a lesser degree the prediction of moderate-severe pain in PACU. The results may also strengthen the manufacturers recommendation of an intraoperative NOL range of 10-25.Australian New Zealand Clinical Trials Registry: ACTRN12619001596190.
伤害感受水平指数（NOL）指导的镇痛先前已被发现与手术期间的有害刺激相关。本研究旨在探讨术中 NOL 与急性术后疼痛之间的关系。在获得机构审查委员会（IRB）批准后，纳入 80 名计划进行非紧急手术的患者。记录从麻醉诱导到手术结束期间的 NOL 数据。患者入住术后急性护理病房（PACU）后，每 5 分钟评估一次疼痛评分（数字评分量表 [NRS，0-10]），共评估 15 分钟。分析了 74 名患者的 NOL 数据。受试者工作特征曲线（ROC）分析确定了 NOL 对刀至皮肤切口的反应（刀至皮肤后 60 秒内的中位数 NOL）与手术期间的中位数 NOL 以及手术结束时的中位数 NOL 与 PACU 中度至重度疼痛的相关性最高（ρ=0.3；P=0.01），ROC 曲线下面积（AUC）也最高（0.68；P=0.01），可预测 PACU 中度至重度疼痛。皮肤切口后 NOL>20 预测术后 PACU 中度至重度疼痛的敏感性最高（73%），特异性（58%）最高。皮肤切口后 NOL<10 可排除 PACU 中度至重度疼痛，阴性预测值为 83%。皮肤切口的 NOL 反应，而不是手术期间的 NOL，似乎可以排除和在一定程度上预测 PACU 中的中度至重度疼痛。这些结果可能还支持制造商建议的术中 NOL 范围为 10-25。澳大利亚和新西兰临床试验注册中心：ACTRN12619001596190。
