Dziodzio Tomasz, Jurth Carlo, Schmid Jan Carlo, Weber Lisa-Marie, Lichtner Gregor, Neudecker Jens, von Dincklage Falk
Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
BIH Charité (Digital) Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany.
J Clin Monit Comput. 2025 Sep 2. doi: 10.1007/s10877-025-01350-7.
Postoperative pain remains a significant adverse event after thoracic surgery, to which intraoperative nociception contributes. To measure intraoperative nociception, the Nociception Level (NOL) monitor is one option. This study aims to assess the NOL's utility for measuring intraoperative nociception and predicting acute postoperative pain and opioid consumption.
This observational study included 114 thoracic surgery patients (37 thoracotomy, 77 minimally invasive surgery) utilizing two analgesic approaches (40 peridural anaesthesia, 74 intercostal nerve block). NOL's utility to monitor responses to incision and nerve block was assessed at population (Wilcoxon-signed-rank tests) and individual level (ROC-analyses). NOL's predictive utility for postoperative pain and opioid consumption was analysed at population (Mann-Whitney-U tests) and individual level (multivariable linear regression).
Population NOL significantly increased after incision and decreased after nerve block (p < 0.01/ p < 0.01) and individual detection of nociception was significantly better than chance (AUCs: 0.68 [95%CI 0.61-0.75] / 0.62 [95%CI 0.53-0.72]). However, NOL did not differ significantly between thoracotomy and minimally invasive surgery (p = 0.12) or peridural anaesthesia and nerve block (p = 0.16), despite significantly different postoperative pain and opioid consumption (p < 0.01). Multivariable analyses showed no significant effect of NOL on postoperative pain or opioid consumption.
NOL captures intraoperative stress with an accuracy allowing to differentiate large nociception changes at both the population and individual level after skin incision and nerve block. However, NOL was unable to differentiate between patients with plausibly different nociception levels, like patients undergoing different surgical or analgesic techniques. Consequently, while NOL can detect large nociceptive changes, its current accuracy may be insufficient to reliably guide individual analgesia in clinical practice.
术后疼痛仍是胸外科手术后的一项重大不良事件，术中伤害感受对此有影响。为了测量术中伤害感受，伤害感受水平（NOL）监测仪是一种选择。本研究旨在评估NOL在测量术中伤害感受以及预测术后急性疼痛和阿片类药物消耗量方面的效用。
这项观察性研究纳入了114例胸外科手术患者（37例行开胸手术，77例行微创手术），采用两种镇痛方法（40例行硬膜外麻醉，74例行肋间神经阻滞）。在总体水平（Wilcoxon符号秩检验）和个体水平（ROC分析）评估NOL监测对切口和神经阻滞反应的效用。在总体水平（Mann-Whitney-U检验）和个体水平（多变量线性回归）分析NOL对术后疼痛和阿片类药物消耗量的预测效用。
总体NOL在切口后显著增加，在神经阻滞后降低（p < 0.01 / p < 0.01），个体对伤害感受的检测显著优于随机水平（曲线下面积：0.68 [95%置信区间0.61 - 0.75] / 0.62 [95%置信区间0.53 - 0.72]）。然而，尽管术后疼痛和阿片类药物消耗量有显著差异（p < 0.01），但开胸手术和微创手术之间（p = 0.12）或硬膜外麻醉和神经阻滞之间（p = 0.16）的NOL并无显著差异。多变量分析显示NOL对术后疼痛或阿片类药物消耗量无显著影响。
NOL能够准确捕捉术中应激，在群体和个体水平上都能区分皮肤切口和神经阻滞后伤害感受的大变化。然而，NOL无法区分伤害感受水平可能不同的患者，如接受不同手术或镇痛技术的患者。因此，虽然NOL可以检测到伤害感受的大变化，但其目前的准确性可能不足以在临床实践中可靠地指导个体镇痛。
