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A2029
October 04, 2020
10/4/2020 12:00:00 PM - 10/4/2020 1:00:00 PM
Room Virtual
Reduced Postoperative Pain In Patients Receiving Opioid-dosing Based On An Artificial Intelligence-driven Nociception Monitor During Elective Noncardiac Surgery
Albert Dahan, M.D.,Ph.D., Fleur Meijer, M.D., Tessa Roor, M.D., Samantha Toet, M.D., Paul Calis, M.D., Martijn Boon, M.D.,Ph.D., Christian Martini, M.D.,Ph.D., Monique van Velzen, Ph.D., Marieke Niesters, M.D.,Ph.D.
LUMC, Leiden, Netherlands
Disclosures: A. Dahan: Funded Research; Self; MSD, Grunenthal, Medasense, AMO, CHDR/Indivior. Consulting Fees; Self; MSD, Medasense. F. Meijer: None. T. Roor: None. S. Toet: None. P. Calis: None. M. Boon: None. C. Martini: None. M. van Velzen: None. M. Niesters: None.
Background: The Nociception Level index (NOL) is a multiparameter index, based on artificial intelligence, designed for monitoring of nociception during anesthesia. We studied the influence of NOL-guided analgesia on postoperative pain scores in patients undergoing abdominal surgery during sevoflurane/fentanyl anesthesia. We hypothesized that more objective fentanyl administration will result in less postoperative pain. Methods: In this randomized controlled trial, performed in two centers, 50 ASA 1-3 patients undergoing abdominal surgery, were randomized to NOL-guided fentanyl dosing or standard care (control). All patients received sevoflurane for anesthesia maintenance. In the NOL-guided group, when NOL values were >25 for at least 1-min, 50-100 μg fentanyl was administered with 5-10 min in between evaluations. After surgery, the primary end-point, pain, was scored using an 11-point rating scale, ranging from 0 (no pain) to 10 (most intense pain imaginable), at 15 min intervals for 90 min.Results: Median postoperative pain scores were 3.2 [interquartile range 1.3 - 4.3] and 4.8 [3.0 - 5.3] in NOL-guided and control groups, respectively (actual difference 1.6, 95% confidence interval 0.5-2.7, p = 0.006). Postoperative morphine consumption was 0.06 ± 0.07 mg/kg (NOL-guided group) and 0.09 ± 0.09 mg/kg (control group; p = 0.204). During surgery, fentanyl dosing was not different between groups. Stress hormones (ACTH and cortisol) measured during and following surgery were on average 50% in patient receiving NOL-guided analgesia compared to standard care during surgery and in the recovery period.Conclusions: Despite no consistent differences in fentanyl and morphine consumption during and following surgery, postoperative pain scores were significantly improved in nociception level index-guided patients. We relate this to a more objective and personalized fentanyl dosing based on nociception during anesthesia resulting in prolonged effects on pain experience.


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