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Online ISSN 1827-1596
Matthias GRUENEWALD 1, Astrid DEMPFLE 2
1 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany; 2 Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany
BACKGROUND: The adequate suppression of nociception is, besides induction of unconsciousness and immobility, the main objective during anaesthesia. Analgesics, most commonly opioids, are usually titrated by established clinical surrogates of nociception. Recently, monitoring techniques became available to evaluate analgesia/nociception during anaesthesia and provide better measures then clinical evaluation alone. They are primarily derived from autonomic response on physiologic standard measures.
METHODS: A literature search and systematic review of randomised controlled trials was performed. Trials enrolling patients undergoing general anaesthesia and comparing the effects of opioids guided by analgesia/nociception monitoring were considered. Studies were analysed regarding the outcome effects of opioid therapy, intraoperative events and postoperative pain. Meta-analyses were performed for each outcome separately using a fixed- effects model and random effects models.
RESULTS: Seven applicable randomised clinical trials using three different methods for analgesia/nociception monitoring and opioid guidance during anaesthesia were found. All but one trial were single centre studies, with a high heterogeneity between the trials and differences in pre-defined primary outcome. This meta-analysis found that the use of analgesia/nociception monitoring was associated with a significant reduction of movement events, a non-significant trend towards reduction of intraoperative administered opioids and emergence time, but was inconclusive with regard to effects on haemodynamic events, postoperatively reported pain and opioid consumption.
CONCLUSIONS: Monitoring analgesia/nociception is often reliant on regular physiologic conditions, like sinus rhythm. Opioid guidance dependent on analgesia/nociception monitoring during anaesthesia may have beneficial and clinically relevant effects, however the number of currently available randomised controlled studies is low and conclusions are hampered by heterogeneity. More studies with focussed clinical endpoints are therefore needed.