在七氟烷麻醉期间采用痛觉水平指导的芬太尼用量可减少术后疼痛：随机对照试验

翻译：佟睿  编辑：冯玉蓉  审校：曹莹

背景：大多数术后患者存在中度到重度疼痛，这可能与手术中阿片类药物剂量过少或过大有关。应用痛觉水平(NOL)指数（一种人工智能驱动的多参数指标，用于监测手术期间的痛觉水平）客观指导阿片类药物的用量，可能会得出更合适的镇痛方案，其效果能够超过手术范围。我们测试了全麻期间NOL指导的阿片类药物使用是否能减少术后疼痛。

方法：在这项双中心随机对照试验中，50名在芬太尼/七氟烷麻醉下接受腹部手术的患者被随机分为NOL指导芬太尼用量方案组和基于血流动力学的标准护理组。研究的主要观察指标是在PACU评估术后疼痛。

结果：NOL指导组和标准护理组术后疼痛评分的中位数分别为3.2(四分位数范围为1.3-4.3)和4.8(3.0-5.3)(P=0.006)。NOL指导组的术后吗啡消耗量(标准差)为0.06(0.07)mg·kg^-1，对照组为0.09(0.09)mg·kg^-1，P=0.204。术中芬太尼用量两组间无差异(NOL指导组 6.4[4.2]mg·kg^-1 vs标准护理组 6.0[2.2]mg·kg^-1，P=0.749)，尽管NOL指导组患者间的变异系数较大(变异系数：NOL指导组 66% vs 标准护理组 37%)。

结论：尽管术中和术后芬太尼和吗啡用量没有差异，但NOL指导组的术后疼痛评分提高了1.6分。我们将其归因于麻醉期间NOL指导的，而不是BP和HR指导的芬太尼用量。

原始文献来源：Fleur Meijer, Maarten Honing, Tessa Roor, et al. Reduced postoperative pain using Nociception Level-guided fentanyl dosing during sevoflurane anaesthesia: a randomised controlled trial.[J].Br J Anesth 2020 Sep 16, DOI: 10.1016/j.bja.2020.07.057.

Reduced postoperative pain using Nociception Level-guided fentanyl dosing during sevoflurane anaesthesia: a randomised controlled trial

Abstract

Background: The majority of postoperative patients report moderate to severe pain, possibly related to opioid underdosing or overdosing during surgery. Objective guidance of opioid dosing using the Nociception Level (NOL) index, a multiparameter artificial intelligence-driven index designed to monitor nociception during surgery, may lead to a more appropriate analgesic regimen, with effects beyond surgery. We tested whether NOL-guided opioid dosing during general anaesthesia results in less postoperative pain.

Methods: In this two-centre RCT, 50 patients undergoing abdominal surgery under fentanyl/sevoflurane anaesthesia were randomised to NOL-guided fentanyl dosing or standard care in which fentanyl dosing was based on haemodynamics. The primary endpoint of the study was postoperative pain assessed in the PACU.

Results: Median postoperative pain scores were 3.2 (inter-quartile range 1.3-4.3) and 4.8 (3.0-5.3) in NOL-guided and standard care groups, respectively (P=0.006). Postoperative morphine consumption (standard deviation) was 0.06 (0.07) mg kg^-1(NOL-guided group) and 0.09 (0.09) mg kg^-1(control group; P=0.204). During surgery, fentanyl dosing was not different between groups (NOL-guided group: 6.4 [4.2] mg kg^-1 vs standard care: 6.0 [2.2] mg kg^-1, P=0.749), although the variation between patients was greater in the NOL-guided group (% coefficient of variation 66% in the NOL-guided group vs 37% in the standard care group).

Conclusions: Despite absence of differences in fentanyl and morphine consumption during and after surgery, a 1.6-point improvement in postoperative pain scores was observed in the NOL-guided group. We attribute this to NOL-driven rather than BP- and HR-driven fentanyl dosing during anaesthesia.