静脉注射芬太尼对行妇科腹腔镜手术患者的术中镇痛作用的识别：NOLGYN 研究的二次分析。

Identification of the intraoperative antinociceptive effect of intravenous fentanyl using the Nociception Level (NOL) index versus clinical parameters in patients undergoing gynecological laparoscopic surgery: A secondary analysis of the NOLGYN study.

机构信息

Department of Mathematical and Industrial Engineering, Polytechnique Montréal, Montréal, Québec, Canada.

Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital Research Centre, CIUSSS de l'Est de l'Ile de Montréal, Montréal, Québec, Canada; Department of Anesthesiology and Pain Medicine, University of Montréal, Montréal, Québec, Canada.

出版信息

Anaesth Crit Care Pain Med. 2022 Aug;41(4):101102. doi: 10.1016/j.accpm.2022.101102. Epub 2022 May 25.

DOI:10.1016/j.accpm.2022.101102

PMID:35643392

Abstract

BACKGROUND

While we typically assess nociception balance during general anesthesia through clinical parameters such as heart rate (HR) and mean arterial pressure (MAP) variation, these parameters are not specific to nociception.

OBJECTIVE

We hypothesized that using the Nociception Level (NOL) index to assess the analgesic effect of a fentanyl bolus would be superior to standard clinical parameters.

DESIGN

Ancillary study of the NOLGYN study, a randomized controlled trial comparing intraoperative NOL-guided administration of fentanyl (NOL group) versus standardized care (SC group).

SETTING

University hospital in Montréal, Canada between November 2018, and December 2019.

PATIENTS

Women undergoing gynecological laparoscopic surgery.

INTERVENTION

In our evaluation of intraoperative nociception, we analyzed the analgesic effect of fentanyl using three parameters: MAP, HR, and the Nociception Level (NOL) index. All fentanyl injection events were extracted from the database.

MAIN OUTCOME MEASURE

The primary endpoint was the difference between values before and after each injection.

RESULTS

The median of the NOL index before fentanyl injection was 30.5 (IQR 19.4 to 40.7) versus 18.9 (IQR 11.5 to 27.4) after (P < 0.001). The median of MAP was 106.4 mmHg (IQR 99.9 to 113.4) before injection versus 103.2 mmHg (IQR 97.5-110.7) after (P < 0.001). The median of HR before injection was 74.2 (IQR 64.2-83.8) versus 72.4 (IQR 63.4-81.3) after (P < 0.001).

CONCLUSIONS

The NOL index, HR, and MAP all statistically discriminated the analgesic effect of fentanyl but only the NOL index proved clinically relevant to identify the analgesic effect of one fentanyl injection.

TRIAL REGISTRATION

www.

CLINICALTRIALS

gov (NCT03776838) registered in October 2018.

摘要

背景

尽管我们通常通过心率 (HR) 和平均动脉压 (MAP) 变化等临床参数评估全身麻醉期间的伤害感受平衡，但这些参数对伤害感受并不具有特异性。

目的

我们假设使用伤害感受指数 (NOL) 评估芬太尼推注的镇痛效果优于标准临床参数。

设计

NOLGYN 研究的辅助研究，这是一项比较术中 NOL 指导下芬太尼给药 (NOL 组) 与标准化护理 (SC 组) 的随机对照试验。

地点

加拿大蒙特利尔大学医院，2018 年 11 月至 2019 年 12 月。

患者

行妇科腹腔镜手术的女性。

干预措施

在我们对术中伤害感受的评估中，我们使用 MAP、HR 和伤害感受指数 (NOL) 分析了芬太尼的镇痛效果。从数据库中提取所有芬太尼注射事件。

主要观察指标

主要终点是每次注射前后的差值。

结果

芬太尼注射前 NOL 指数中位数为 30.5（IQR 19.4 至 40.7），注射后为 18.9（IQR 11.5 至 27.4）（P < 0.001）。MAP 中位数为注射前 106.4mmHg（IQR 99.9 至 113.4），注射后为 103.2mmHg（IQR 97.5 至 110.7）（P < 0.001）。HR 中位数为注射前 74.2（IQR 64.2 至 83.8），注射后为 72.4（IQR 63.4 至 81.3）（P < 0.001）。