Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, İstanbul-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Jun;30(6):415-422. doi: 10.14744/tjtes.2024.95533.
Effective pain management is vital in critical care settings, particularly post-surgery. Clinicians should maintain objective and efficient standards to assess pain in a patient-centered manner, in order to effectively manage this complex issue. A newer technology, the nociception level (NOL) index, shows promise in achieving this task through its multi-parameter evaluation.
This study was a prospective, controlled, randomized trial involving two groups of patients (n=30 each) in a diverse intensive care unit. Participants were over 18 years old with American Society of Anesthesiology scores ranging from I to III and were scheduled for critical care follow-up after general anesthesia. All subjects followed a standard analgesia protocol that included rescue analgesia. Drug administration was guided by a numeric rating scale and the critical care pain observation tool in the Control Group, while it was guided by nociception level index monitoring in the NOL Group.
Pain scores between the two groups did not significantly differ. However, within the NOL Group, pain scores and noci-ception values displayed a strong positive correlation. Notably, total analgesic consumption was significantly lower in the NOL Group (p=0.036).
Monitoring pain using the nociception level index is an effective method for detecting pain compared to standard pain scores utilized in critical care. Its guidance facilitates personalized analgesic titration. Additionally, the potential of nociception level index guidance to reduce the duration of intensive care and hospital stays may be linked to its effects on delirium, a connection that awaits further exploration in future studies.
有效的疼痛管理在重症监护环境中至关重要，尤其是手术后。临床医生应保持客观和高效的标准，以患者为中心评估疼痛，从而有效地处理这个复杂的问题。一种较新的技术，伤害感受水平（NOL）指数，通过其多参数评估显示出在实现这一任务方面的潜力。
这是一项前瞻性、对照、随机试验，涉及一个多样化的重症监护病房的两组患者（每组 30 人）。参与者年龄在 18 岁以上，美国麻醉医师协会评分在 I 到 III 之间，在全身麻醉后计划进行重症监护随访。所有患者均遵循标准镇痛方案，包括抢救性镇痛。在对照组中，药物管理由数字评分量表和重症监护疼痛观察工具指导，而在 NOL 组中则由伤害感受水平指数监测指导。
两组患者的疼痛评分无显著差异。然而，在 NOL 组中，疼痛评分和伤害感受值之间存在强烈的正相关。值得注意的是，NOL 组的总镇痛药物消耗量显著降低（p=0.036）。
与重症监护中使用的标准疼痛评分相比，使用伤害感受水平指数监测疼痛是一种有效的方法。与标准疼痛评分相比，它的指导可以促进个性化的镇痛滴定。此外，伤害感受水平指数指导降低重症监护和住院时间的可能性可能与其对谵妄的影响有关，这一关联有待未来研究进一步探索。
