Ziebart Alexander, Rothgerber David-Jonas, Woldt Sophia, Mackert Katharina, Heiden Julia, Schuster Michael, Kamuf Jens, Griemert Eva-Verena, Ruemmler Robert
Department of Anesthesiology, University Medical Centre, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany.
J Clin Med. 2024 Aug 22;13(16):4968. doi: 10.3390/jcm13164968.
: The NOL system (PMD-200™ Nociception Level Monitor; Medasense Ltd., Ramat Gan, Israel) is used for the real-time detection of physiological nociception in anesthetized patients by assessing the parameters indicative of sympathetic activity, such as photoplethysmography, skin conductance, peripheral temperature, and accelerometry, which are quantified into the NOL-Index. This index is more sensitive than traditional clinical parameters in estimating pain and stress responses. While its effectiveness in general anesthesia is well documented, its efficacy in epidural anesthesia needs further investigation. : This retrospective study analyzed NOL-Index dynamics compared to conventional parameters after epidural administration of bupivacaine. Following ethics committee approval, 119 NOL measurements were retrospectively analyzed after thoracic epidural catheter administration in 40 patients undergoing abdominal and urological surgery. The NOL-Index was assessed at 0, 1, 3, and 5 min post application and compared to heart rate, blood pressure, and bispectral index dynamics. : This study showed a significant decrease in the NOL-Index post-local-anesthetic administration with better sensitivity than classical clinical parameters (0 min = 38 ± 11; 1 min = 22 ± 13*; 3 min = 17 ± 11*; 5 min = 12 ± 10*). Higher doses of local anesthetics led to a significant, dose-dependent decrease in NOL-Index (low dose, 5 min = 15 ± 10*; high dose, 5 min = 8 ± 8*). : This study is the first to demonstrate the effectiveness of the NOL-Index in measuring nociceptive effects following epidural administration, highlighting its potential superiority over conventional parameters and its sensitivity to dose variations.
NOL系统（PMD - 200™痛觉水平监测仪；以色列拉马特甘的Medasense有限公司）用于通过评估指示交感神经活动的参数，如光电容积脉搏波描记法、皮肤电导率、外周温度和加速度测量，对麻醉患者的生理痛觉进行实时检测，这些参数被量化为NOL指数。该指数在估计疼痛和应激反应方面比传统临床参数更敏感。虽然其在全身麻醉中的有效性已有充分记录，但其在硬膜外麻醉中的疗效仍需进一步研究。：这项回顾性研究分析了布比卡因硬膜外给药后NOL指数动态变化与传统参数的比较。经伦理委员会批准，对40例接受腹部和泌尿外科手术的患者在胸段硬膜外导管给药后进行了119次NOL测量的回顾性分析。在应用后0、1、3和5分钟评估NOL指数，并与心率、血压和双谱指数动态变化进行比较。：这项研究表明，局部麻醉药给药后NOL指数显著下降，其敏感性优于经典临床参数（0分钟 = 38 ± 11；1分钟 = 22 ± 13*；3分钟 = 17 ± 11*；5分钟 = 12 ± 10*）。更高剂量的局部麻醉药导致NOL指数显著的剂量依赖性下降（低剂量，5分钟 = 15 ± 10*；高剂量，5分钟 = 8 ± 8*）。：这项研究首次证明了NOL指数在测量硬膜外给药后痛觉效应方面的有效性，突出了其相对于传统参数的潜在优势及其对剂量变化的敏感性。
