Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.07.010
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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Abstract

Background
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.

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

Keywords

Nociception;  Pain;  Perioperative medicine;  Monitoring

Resumo

Introdução
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.

Conclusão
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.

Palavras-chave

Nocicepção;  Dor;  Medicina perioperatória;  Monitorização

References

1 C.L. Wu, A.B. King, T.M. Geiger, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Opioid Minimization in Opioid-Naive Patients Anesth Analg., 129 (2019), pp. 567-577

2 C.E. Nightingale, M.P. Margarson, E. Shearer, et al. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia Anaesthesia., 7 (2015), pp. 859-876

3 M. Bakan, T. Umutoglu, U. Topuz, et al. Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study Brazilian J Anesthesiol (English Ed), 65 (2015), pp. 191-199

4 G. Turan, A.Y. Ar, Y.Y. Kuplay, et al. Analgesia Nociception Index for perioperative analgesia monitoring in spinal surgery Brazilian J Anesthesiol (English Ed), 67 (2017), pp. 370-375

5 R. Abdullayev, O. Uludag, B. Celik Analgesia Nociception Index: assessment of acute postoperative pain Brazilian J Anesthesiol., 69 (2019), pp. 396-402

6 D.W.P. Williams, J. Koenig, L. Carnevali, et al. Heart rate variability and inflammation: A meta-analysis of human studies Brain Behav Immun., 80 (2019), pp. 219-226

7 S. Coeckelenbergh, C. Zaouter, B. Alexander, et al. Automated systems for perioperative goal-directed hemodynamic therapy J Anesth., 34 (2020), pp. 104-114
 

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