Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
Anaesthesia. 2023 Dec;78(12):1493-1501. doi: 10.1111/anae.16148. Epub 2023 Oct 21.
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.
急性术后疼痛仍然是一个关键的治疗重点，并促使人们寻找技术和方法来协助术中镇痛监测和管理。麻醉师传统上依赖临床判断来指导术中镇痛，但一些新兴技术，如伤害感受水平指数，预示着常规术中镇痛监测的可能性。然而，伤害感受水平指数等设备对术后结果的影响尚未得到证实。我们对比较伤害感受水平指数指导的镇痛与标准护理的文章进行了系统评价和荟萃分析。主要结局是手术后 60-120 分钟内的疼痛强度和阿片类药物消耗量。次要结局是术后恶心和呕吐的发生率以及在麻醉后恢复室的停留时间。共有 10 项研究，共包括 662 名患者，发表于 2019 年至 2023 年之间，符合定性系统评价和定量荟萃分析的纳入标准。方法学偏倚的风险通常较低或不明确，其中 6 项研究报告了与研究结果相关的重大利益冲突。我们的荟萃分析使用随机效应模型进行。它发现伤害感受水平指数指导的镇痛在早期术后疼痛方面具有统计学显著的益处（11 点量表上的平均（95%CI）差异-0.46（-0.88 至 -0.03），p=0.03），以及阿片类药物需求（平均（95%CI）差异-1.04（-1.94 至 -0.15）mg 静脉吗啡当量，p=0.02）。我们对当前文献的荟萃分析发现，伤害感受水平指数指导的镇痛在统计学上显著降低了报告的术后疼痛强度和阿片类药物消耗，但未能显示出具有临床意义的结果。我们没有发现伤害感受水平指数指导的镇痛对术后恶心和呕吐以及麻醉后恢复室停留时间有影响的证据。
