From the Department of Anesthesiology and Reanimation, Koç University School of Medicine, Istanbul, Turkey.
Department of Anesthesiology and Reanimation, Acibadem University School of Medicine, Istanbul, Turkey.
Anesth Analg. 2024 Nov 1;139(5):978-985. doi: 10.1213/ANE.0000000000007180. Epub 2024 Aug 2.
The nociception level (NOL) index is a quantitative parameter derived from physiological signals to measure intraoperative nociception. The aim of this systematic review and meta-analysis was to evaluate if NOL monitoring reduces intraoperative opioid use compared to conventional therapy (opioid administered at clinician discretion).
This meta-analysis comprises randomized clinical trials comparing NOL-guided opioid administration to conventional therapy in adult patients undergoing any type of surgery. A systematic search of PubMed, Scopus, and CENTRAL databases was conducted. The primary outcome was intraoperative opioid consumption and the effect estimate of the NOL index was measured using the standardized mean difference (SMD) where 0.20 is considered a small and 0.80 a large effect size. A random-effects model with Hartung-Knapp-Sidik-Jonkman adjustment was applied to estimate the treatment effect. Heterogeneity was explored clinically and statistically (using the inconsistency I ² statistic, prediction intervals, and influence analysis). The quality (certainty) of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines methodology.
This review comprised 9 trials (519 patients). The intraoperative opioid SMD (NOL monitoring versus conventional therapy) was -0.26 (95% confidence interval [CI], -0.82 to 0.30; P = .31; low certainty of evidence). We observed substantial clinical (intraoperative opioid regimens) and statistical heterogeneity with the I ² statistic being 86% (95% CI, 75%-92%). The prediction interval was between -1.95 and 1.42 indicating where the SMD between NOL and conventional therapy would lie if a similar study were conducted in the future.
This meta-analysis does not provide evidence supporting the role of NOL monitoring in reducing intraoperative opioid consumption.
伤害感受水平（NOL）指数是一种从生理信号中得出的定量参数，用于测量术中伤害感受。本系统评价和荟萃分析的目的是评估与常规治疗（根据临床医生的判断给予阿片类药物）相比，NOL 监测是否能减少术中阿片类药物的使用。
本荟萃分析包括比较 NOL 指导下阿片类药物给药与常规治疗在接受任何类型手术的成年患者中的随机临床试验。对 PubMed、Scopus 和 CENTRAL 数据库进行了系统搜索。主要结局是术中阿片类药物的消耗，使用标准化均数差（SMD）来衡量 NOL 指数的效应估计值，其中 0.20 被认为是小效应，0.80 是大效应。采用随机效应模型和 Hartung-Knapp-Sidik-Jonkman 调整来估计治疗效果。通过临床和统计学（使用不一致 I ² 统计、预测区间和影响分析）来探索异质性。使用推荐评估、制定与评价（GRADE）指南方法评估证据的质量（确定性）。
本综述包括 9 项试验（519 名患者）。术中阿片类药物 SMD（NOL 监测与常规治疗）为-0.26（95%置信区间 [CI]，-0.82 至 0.30；P =.31；证据确定性低）。我们观察到较大的临床（术中阿片类药物方案）和统计学异质性，I ² 统计值为 86%（95%CI，75%-92%）。预测区间在-1.95 和 1.42 之间，这表明如果未来进行类似的研究，NOL 和常规治疗之间的 SMD 将处于何处。
本荟萃分析没有提供支持 NOL 监测在减少术中阿片类药物消耗中的作用的证据。
