Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Case Report

Guiding opioid-free intravenous antinociception with the Analgesia Nociception Index: a case report

Antinocicepção intravenosa sem opioides orientada pelo Índice de Analgesia/Nocicepção: relato de caso

Sean Coeckelenbergh, Jean-Pierre Estebe

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Opioid-free anesthesia decreases the incidence of opioid adverse events, but its optimal antinociceptive depth has not been clearly defined. Personalizing intraoperative opioid-free infusions with a nociception monitor may be the solution.

Case report
We describe the feasibility and potential limitations of titrating opioid-free antinociception during major abdominal surgery using the Analgesia Nociception Index (Mdoloris, Lille, France) in an obese patient. After stabilizing the patient’s nociception-antinociception balance intraoperatively we quickly reversed anesthesia and the patient did not require postoperative opioids.

Personalizing opioid-free antinociception with a nociception monitor is feasible. It may optimize intraoperative antinociception and improve postoperative comfort.


Nociception;  Pain;  Perioperative medicine;  Monitoring


A anestesia sem opioides diminui a incidência de eventos adversos associados aos opioides, mas a profundidade antinociceptiva ideal dessa abordagem não está claramente definida. Personalizar a infusão intraoperatória sem opioides através do uso de monitor de nocicepção pode ser a solução.

Relato de caso
Descrevemos a viabilidade e as eventuais limitações da titulação da antinocicepção sem opioides através do uso do Índice de Analgesia/Nocicepção (Mdoloris, Lille, França) durante cirurgia abdominal de grande porte em paciente com obesidade. Depois de estabilizar o equilíbrio nocicepção-antinocicepção da paciente no intraoperatório, revertemos rapidamente a anestesia e a paciente não precisou de opioides no pós-operatório.

A personalização da antinocicepção sem opioides através do emprego de monitor de nocicepção é factível. A abordagem pode otimizar a antinocicepção intraoperatória e melhorar o conforto pós-operatório.


Nocicepção;  Dor;  Medicina perioperatória;  Monitorização


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