Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2016.07.010
Brazilian Journal of Anesthesiology
Scientific Article

Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery

Índice de analgesia/nocicepção para monitorização da analgesia perioperatória na cirurgia da coluna vertebral

Guldem Turan; Arzu Yı; ldı; rı; m Ar; Yı; ldı; z Yigit Kuplay; Oznur Demiroluk; Mustafa Gazi; Nur Akgun; Erhan Celikoglu

http://dx.doi.org/10.1016/j.bjane.2016.07.010 Braz J Anesthesiol, vol.67, n4, p.370-375, 2017
PDF English
PDF Português
Downloads: 5
Views: 1057

Abstract

Abstract Background and objectives: The Analgesia Nociception Index is an index used to measure the levels of pain, sympathetic system activity and heart rate variability during general anesthesia. In our study, Analgesia Nociception Index monitoring in two groups who had undergone spinal stabilization surgery and were administered propofol-remifentanil (Total Intravenous Anesthesia) and sevoflurane-remifentanyl anesthesia was compared regarding its significance for prediction of postoperative early pain. Methods: BIS and Analgesia Nociception Index monitoring were conducted in the patients together with standard monitoring. During induction, fentanyl 2 µg.kg-1, propofol 2.5 mg.kg-1 and rocuronium 0.6 mg.kg-1 were administered. During maintenance, 1.0 MAC sevoflurane + remifentanil 0.05-0.3 µg.kg-1.min-1 and propofol 50-150 µg.kg-1.min-1 + remifentanil 0.05-0.3 µg.kg-1.min-1 were administered in Group S and Group T, respectively. Hemodynamic parameters, BIS and Analgesia Nociception Index values were recorded during surgery and 30 min postoperatively. Postoperative visual analog scale (VAS) values at 30 minutes were recorded. Results: While no difference was found between mean Analgesia Nociception Index at all times of measurement in both groups, Analgesia Nociception Index measurements after administration of perioperative analgesic drug were recorded to be significantly higher compared to baseline values in both groups. There was correlation between mean values of Analgesia Nociception Index and VAS after anesthesia. Conclusion: Analgesia Nociception Index is a valuable parameter for monitoring of perioperative and postoperative analgesia. In spine surgery, similar analgesia can be provided in both Total Intravenous Anesthesia with remifentanil and sevoflurane administration. Analgesia Nociception Index is efficient for prediction of the need for analgesia during the early postoperative period, and therefore is the provision of patient comfort.

Keywords

Analgesia Nociceptive Index, Sevoflurane, TIVA, Spinal surgery

Resumo

Resumo Justificativa e objetivos: O índice de analgesia/nocicepção (ANI) é usado para medir os níveis de dor, a atividade do sistema simpático e a variabilidade da frequência cardíaca durante a anestesia geral. Em nosso estudo, a monitoração do ANI em dois grupos que foram submetidos à cirurgia de estabilização da coluna vertebral e receberam propofol-remifentanil (Total Intravenous Anesthesia - TIVA) e sevoflurano-remifentanil foram comparados para identificar sua importância na previsão precoce de dor no pós-operatório. Métodos: Os pacientes foram monitorados com o uso de BIS e ANI juntamente com a monitoração padrão. Durante a indução, fentanil (2 µg.kg-1), propofol (2,5 mg.kg-1) e rocurônio (0,6 mg.kg-1) foram administrados. Durante a manutenção, 1 CAM de sevoflurano + remifentanil (0,05-0,3 µg.kg-1.min-1) e propofol (50-150 µg.kg-1.min-1) + remifentanil (0,05-0,3 µg.kg-1.min-1) foram administrados aos grupos S e T, respectivamente. Parâmetros hemodinâmicos, valores de BIS e ANI foram registrados durante a cirurgia e aos 30 minutos de pós-operatório. Os valores escala visual analógica (EVA) aos 30 minutos de pós-operatório foram registrados. Resultados: Enquanto não observamos diferença entre as médias do ANI em todos os tempos de mensuração de ambos os grupos, as mensurações do ANI após a administração do analgésico no perioperatório foram significativamente maiores do que os valores basais de ambos os grupos. Houve correlação entre as médias dos valores de ANI e EVA após a anestesia. Conclusão: ANI é um parâmetro importante para o monitoração de analgesia nos períodos perioperatório e pós-operatório. Na cirurgia da coluna vertebral, analgesia semelhante pode ser obtida com anestesia intravenosa total com remifentanil e com a administração de sevoflurano. O ANI é eficiente para prever a necessidade de analgesia durante o período pós-operatório imediato e, portanto, para proporcionar conforto ao paciente.

Palavras-chave

Índice de analgesia/nocicepção, Sevoflurano, TIVA, Cirurgia de coluna vertebral

References

Logier R, Jeanne M, De Jonckheere J. PhysioDoloris: a monitoring device for analgesia/nociception balance evaluation using heart rate variability analysis. Conf Proc IEEE Eng Med Biol Soc. 2010;2010:1194-7.

De Jonckheere J, Delecroix M, Jeanne M. Automated analgesic drugs delivery guided by vagal tone evaluation: interest of the Analgesia Nociception Index (ANI). Conf Proc IEEE Eng Med Biol Soc. 2013:1952-5.

De Jonckheere J, Rommel D, Nandrino JL. Heart rate variability analysis as an index of emotion regulation processes: interest of the Analgesia Nociception Index (ANI). Conf Proc IEEE Eng Med Biol Soc. 2012:3432-5.

Jeanne M, Logier R, De Jonckheere J. Heart rate variability during total intravenous anesthesia: effects of nociception and analgesia. Auton Neurosci. 2009;147:91-6.

Jeanne M, Clément C, De Jonckheere J. Variations of the analgesia nociception index during general anaesthesia for laparoscopic abdominal surgery. J Clin Monit Comput. 2012;26:289-94.

Ledowski T, Averhoff L, Tiong WS. Analgesia Nociception Index (ANI) to predict intraoperative haemodynamic changes: results of a pilot investigation. Acta Anaesthesiol Scand. 2014;58:74-9.

Szental JA, Webb A, Weeraratne C. Postoperative pain after laparoscopic cholecystectomy is not reduced by intraoperative analgesia guided by analgesia nociception index (ANI®) monitoring: a randomized clinical trial. Br J Anaesth. 2015;114:640-5.

Jeanne M, Delecroix M, De Jonckheere J. Variations of the analgesia nociception index during propofol anesthesia for total knee replacement. Clin J Pain. 2014;30:1084-8.

Logier R, De Jonckheere J, Delecroix M. Heart rate variability analysis for arterial hypertension etiological diagnosis during surgical procedures under tourniquet. Conf Proc IEEE Eng Med Biol Soc. 2011;2011:3776-9.

Boselli E, Bouvet L, Begou G. Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study. Br J Anaesth. 2014;112:715-21.

Ledowski T, Tiong WS, Lee C. Analgesia nociception index: evaluation as a new parameter for acute postoperative pain. Br J Anaesth. 2013;111:627-9.

Gruenewald M, Ilies C, Herz J. Influence of nociception stimulation on analgesia nociception index (ANI) during propofol-remifentanyl anaesthesia. Br J Anaesth. 2013;110:1024-30.

Gruenewald M, Ilies C, Herz J. Measurement of the nociceptive balance by analgesia nociception index (ani) and surgical pleth index (spi) during sevoflurane-remifentanyl anaesthesia. Minerva Anestesiol. 2015;81:480-9.

Bollag L, Ortner CM, Jelacic S. The effects of low-dose ketamine on the analgesia nociception index (ANI) measured with the novel PhysioDoloris™ analgesia monitor: a pilot study. J Clin Monit Comput. 2015;29:291-5.

Sabourdin N, Arnaout M, Louvet N. Pain monitoring in anesthetized children: first assessment of skin conductance and analgesia-nociception index at different infusion rates of remifentanyl. Pediatr Anesth. 2013;23:149-55.

5dcd41e60e88255c24bf58f2 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections