Analgesia: Effects on Response to Nociceptive Stimulation

doi:10.1017/9781316443217.008

8 - Analgesia: Effects on Response to Nociceptive Stimulation

from Section 2 - Targeting Effects

Published online by Cambridge University Press: 03 December 2019

Emmanuel Boselli and

Mathieu Jeanne

Edited by

Pedro L. Gambús and

Jan F. A. Hendrickx

Show author details

Pedro L. Gambús: Affiliation:
Hospital Clinic de Barcelona, Spain
Jan F. A. Hendrickx: Affiliation:
Aalst General Hospital, Belgium

Book contents

Get access

Summary

Conscious patients undergoing regional anaesthesia are able to interact with caregivers and indicate when they are feeling pain and/or anxiety during surgery. Unconscious patients on the other hand, not only in the operating room but also in intensive care, need antinociception when a nociceptive stimulus is applied. In these patients, the dose of antinociceptive drugs cannot be adjusted or the effect of locoregional anaesthesia supplementing general anaesthesia cannot be determined by simply asking the patient. Thus, the clinician needs to rely on monitors of the nociception/antinociception (N/AN) balance to be able to provide adequate, that is personalized, antinociception.

Type: Chapter
Information: Personalized Anaesthesia
Targeting Physiological Systems for Optimal Effect
, pp. 117 - 127

DOI: https://doi.org/10.1017/9781316443217.008 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Aranake, A, Mashour, GA, Avidan, MS: Minimum alveolar concentration: ongoing relevance and clinical utility. Anaesthesia. 2013; 68: 512–22.Google Scholar

Minto, CF, Schnider, TW: Contributions of PK/PD modeling to intravenous anesthesia. Clin.Pharmacol.Ther. 2008; 84: 27–38.Google Scholar

Checketts, MR, Alladi, R, Ferguson, K, Gemmell, L, Handy, JM, Klein, AA, Love, NJ, Misra, U, Morris, C, Nathanson, MH, Rodney, GE, Verma, R, Pandit, JJ: Recommendations for standards of monitoring during anaesthesia and recovery 2015: Association of Anaesthetists of Great Britain and Ireland. Anaesthesia. 2016; 71: 85–93.CrossRef Google Scholar PubMed

Lien, CA, Kopman, AF: Current recommendations for monitoring depth of neuromuscular blockade. Curr.Opin.Anaesthesiol. 2014; 27: 616–22.Google Scholar

Punjasawadwong, Y, Boonjeungmonkol, N, Phongchiewboon, A: Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst. Rev. 2007: CD003843.Google Scholar

Chhabra, A, Subramaniam, R, Srivastava, A, Prabhakar, H, Kalaivani, M, Paranjape, S: Spectral entropy monitoring for adults and children undergoing general anaesthesia. Cochrane Database Syst. Rev. 2016; 3: CD010135.Google Scholar

Gruenewald, M, Ilies, C: Monitoring the nociception-anti-nociception balance. Best Pract.Res.Clin.Anaesthesiol. 2013; 27: 235–47.CrossRef Google Scholar PubMed

De Jonckheere, J, Bonhomme, V, Jeanne, M, Boselli, E, Gruenewald, M, Logier, R, Richebe, P: Physiological signal processing for individualized anti-nociception management during general anesthesia: A review. Yearb.Med.Inform. 2015; 10: 95–101.Google Scholar

Jensen, EW, Valencia, JF, Lopez, A, Anglada, T, Agusti, M, Ramos, Y, Serra, R, Jospin, M, Pineda, P, Gambus, P: Monitoring hypnotic effect and nociception with two EEG-derived indices, qCON and qNOX, during general anaesthesia. Acta Anaesthesiol. Scand. 2014; 58: 933–41.Google Scholar

Boselli, E, Bouvet, L, Allaouchiche, B: Analgesia monitoring using Analgesia/Nociception Index: Results of clinical studies in awake and anesthetized patients. Le Praticien en Anesthésie Réanimation 2015; 19: 78–86.Google Scholar

Logier, R, Jeanne, M, De Jonckheere, J, Dassonneville, A, Delecroix, M, Tavernier, B: PhysioDoloris: a monitoring device for analgesia / nociception balance evaluation using heart rate variability analysis. Conf.Proc.IEEE.Eng.Med.Biol.Soc. 2010; 2010: 1194–7.Google Scholar

Sabourdin, N, Arnaout, M, Louvet, N, Guye, ML, Piana, F, Constant, I: Pain monitoring in anesthetized children: first assessment of skin conductance and analgesia-nociception index at different infusion rates of remifentanil. Paediatr.Anaesth. 2013; 23: 149–55.Google Scholar

Migeon, A, Desgranges, FP, Chassard, D, Blaise, BJ, De Queiroz, M, Stewart, A, Cejka, JC, Combet, S, Rhondali, O: Pupillary reflex dilatation and analgesia nociception index monitoring to assess the effectiveness of regional anesthesia in children anesthetised with sevoflurane. Paediatr.Anaesth. 2013; 23: 1160–5.Google Scholar

Jordan, D, Steiner, M, Kochs, EF, Schneider, G: A program for computing the prediction probability and the related receiver operating characteristic graph. Anesth.Analg. 2010; 111: 1416–21.Google Scholar

Ledowski, T, Averhoff, L, Tiong, WS, Lee, C: Analgesia Nociception Index (ANI) to predict intraoperative haemodynamic changes: results of a pilot investigation. Acta.Anaesthesiol.Scand. 2013; 58: 74–9.Google Scholar

Jeanne, M, Delecroix, M, De Jonckheere, J, Keribedj, A, Logier, R, Tavernier, B: Variations of the analgesia nociception index during propofol anesthesia for total knee replacement. Clin.J.Pain. 2014; 30: 1084–8.CrossRef Google Scholar PubMed

Boselli, E, Bouvet, L, Bégou, G, Torkmani, S, Allaouchiche, B: Prediction of hemodynamic reactivity during total intravenous anesthesia for suspension laryngoscopy using Analgesia/Nociception Index (ANI): a prospective observational study. Minerva.Anestesiol. 2015; 81: 288–97.Google Scholar

Boselli, E, Logier, R, Bouvet, L, Allaouchiche, B: Prediction of hemodynamic reactivity using dynamic variations of Analgesia/Nociception Index (ANI). J.Clin.Monit.Comput. 2016; 30: 977–84.Google Scholar

Boselli, E, Jeanne, M: Analgesia/nociception index for the assessment of acute postoperative pain. Br.J.Anaesth. 2014; 112: 936–7.Google Scholar

Egan, TD: Remifentanil pharmacokinetics and pharmacodynamics. A preliminary appraisal. Clin.Pharmacokinet. 1995; 29: 80–94.Google Scholar

Boselli, E, Bouvet, L, Bégou, G, Dabouz, R, Davidson, J, Deloste, JY, Rahali, N, Zadam, A, Allaouchiche, B: Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study. Br.J.Anaesth. 2014; 112: 715–21.Google Scholar

Szental, JA, Webb, A, Weeraratne, C, Campbell, A, Sivakumar, H, Leong, S: Postoperative pain after laparoscopic cholecystectomy is not reduced by intraoperative analgesia guided by analgesia nociception index (ANI(R)) monitoring: a randomized clinical trial. Br.J.Anaesth. 2015; 114: 640–5.Google Scholar

Upton, HD, Ludbrook, GL, Wing, A, Sleigh, JW: Intraoperative “Analgesia Nociception Index”-guided fentanyl administration during sevoflurane anesthesia in lumbar discectomy and laminectomy: a randomized clinical trial. Anesth.Analg. 2017; 125: 81–90.Google Scholar

Rossi, M, Cividjian, A, Fevre, MC, Oddoux, ME, Carcey, J, Halle, C, Frost, M, Gardellin, M, Payen, JF, Quintin, L: A beat-by-beat, on-line, cardiovascular index, CARDEAN, to assess circulatory responses to surgery: a randomized clinical trial during spine surgery. J.Clin.Monit.Comput. 2012; 26: 441–9.Google Scholar

Larson, MD, Behrends, M: Portable infrared pupillometry: a review. Anesth.Analg. 2015; 120: 1242–53.Google Scholar

Guignard, B: Monitoring analgesia. Best.Pract.Res.Clin.Anaesthesiol. 2006; 20: 161–80.CrossRef Google Scholar PubMed

Larson, MD, Kurz, A, Sessler, DI, Dechert, M, Bjorksten, AR, Tayefeh, F: Alfentanil blocks reflex pupillary dilation in response to noxious stimulation but does not diminish the light reflex. Anesthesiology. 1997; 87: 849–55.Google Scholar

Barvais, L, Engelman, E, Eba, JM, Coussaert, E, Cantraine, F, Kenny, GN: Effect site concentrations of remifentanil and pupil response to noxious stimulation. Br.J.Anaesth. 2003; 91: 347–52.Google Scholar

Constant, I, Nghe, MC, Boudet, L, Berniere, J, Schrayer, S, Seeman, R, Murat, I: Reflex pupillary dilatation in response to skin incision and alfentanil in children anaesthetized with sevoflurane: a more sensitive measure of noxious stimulation than the commonly used variables. Br.J.Anaesth. 2006; 96: 614–19.CrossRef Google Scholar

Guglielminotti, J, Grillot, N, Paule, M, Mentre, F, Servin, F, Montravers, P, Longrois, D: Prediction of movement to surgical stimulation by the pupillary dilatation reflex amplitude evoked by a standardized noxious test. Anesthesiology. 2015; 122: 985–93.Google Scholar

Isnardon, S, Vinclair, M, Genty, C, Hebrard, A, Albaladejo, P, Payen, JF: Pupillometry to detect pain response during general anaesthesia following unilateral popliteal sciatic nerve block: a prospective, observational study. Eur.J.Anaesthesiol. 2013; 30: 429–34.Google Scholar

Storm, H: Changes in skin conductance as a tool to monitor nociceptive stimulation and pain. Curr.Opin.Anaesthesiol. 2008; 21: 796–804.Google Scholar

Ledowski, T, Pascoe, E, Ang, B, Schmarbeck, T, Clarke, MW, Fuller, C, Kapoor, V: Monitoring of intra-operative nociception: skin conductance and surgical stress index versus stress hormone plasma levels. Anaesthesia. 2010; 65: 1001–6.Google Scholar

Ledowski, T, Bromilow, J, Paech, MJ, Storm, H, Hacking, R, Schug, SA: Monitoring of skin conductance to assess postoperative pain intensity. Br.J.Anaesth. 2006; 97: 862–5.Google Scholar

Ledowski, T, Bromilow, J, Wu, J, Paech, MJ, Storm, H, Schug, SA: The assessment of postoperative pain by monitoring skin conductance: results of a prospective study. Anaesthesia. 2007; 62: 989–93.Google Scholar

Hullett, B, Chambers, N, Preuss, J, Zamudio, I, Lange, J, Pascoe, E, Ledowski, T. Monitoring electrical skin conductance: a tool for the assessment of postoperative pain in children? Anesthesiology. 2009; 111: 513–17.Google Scholar

Ledowski, T, Bromilow, J, Paech, MJ, Storm, H, Hacking, R, Schug, SA. Skin conductance monitoring compared with Bispectral Index to assess emergence from total i.v. anaesthesia using propofol and remifentanil. Br.J.Anaesth. 2006; 97: 817–21.Google Scholar

Ledowski, T, Preuss, J, Ford, A, Paech, MJ, McTernan, C, Kapila, R, Schug, SA: New parameters of skin conductance compared with Bispectral Index monitoring to assess emergence from total intravenous anaesthesia. Br.J.Anaesth. 2007; 99: 547–51.CrossRef Google Scholar PubMed

Ledowski, T, Preuss, J, Kapila, R, Ford, A: Skin conductance as a means to predict hypotension following spinal anaesthesia. Acta.Anaesthesiol.Scand. 2008; 52: 1342–7.Google Scholar

Ledowski, T, Paech, MJ, Browning, R, Preuss, J, Schug, SA. An observational study of skin conductance monitoring as a means of predicting hypotension from spinal anaesthesia for caesarean delivery. Int.J.Obstet.Anesth.2010; 19: 282–6.Google Scholar

Huiku, M, Uutela, K, van Gils, M, Korhonen, I, Kymalainen, M, Merilainen, P, Paloheimo, M, Rantanen, M, Takala, P, Viertio-Oja, H, Yli-Hankala, A: Assessment of surgical stress during general anaesthesia. Br.J.Anaesth. 2007; 98: 447–55.Google Scholar

Struys, MM, Vanpeteghem, C, Huiku, M, Uutela, K, Blyaert, NB, Mortier, EP: Changes in a surgical stress index in response to standardized pain stimuli during propofol-remifentanil infusion. Br.J.Anaesth. 2007; 99: 359–67.Google Scholar

Bonhomme, V, Uutela, K, Hans, G, Maquoi, I, Born, JD, Brichant, JF, Lamy, M, Hans, P: Comparison of the surgical Pleth Index with haemodynamic variables to assess nociception-anti-nociception balance during general anaesthesia. Br.J.Anaesth. 2011; 106: 101–11.Google Scholar

Chen, X, Thee, C, Gruenewald, M, Wnent, J, Illies, C, Hoecker, J, Hanss, R, Steinfath, M, Bein, B: Comparison of surgical stress index-guided analgesia with standard clinical practice during routine general anesthesia: a pilot study. Anesthesiology. 2010; 112: 1175–83.Google Scholar

Bergmann, I, Gohner, A, Crozier, TA, Hesjedal, B, Wiese, CH, Popov, AF, Bauer, M, Hinz, JM: Surgical pleth index-guided remifentanil administration reduces remifentanil and propofol consumption and shortens recovery times in outpatient anaesthesia. Br.J.Anaesth 2013; 110: 622–8.Google Scholar

Ben-Israel, N, Kliger, M, Zuckerman, G, Katz, Y, Edry, R: Monitoring the nociception level: a multi-parameter approach. J.Clin.Monit.Comput. 2013;Google Scholar

Martini, CH, Boon, M, Broens, SJ, Hekkelman, EF, Oudhoff, LA, Buddeke, AW, Dahan, A: Ability of the nociception level, a multiparameter composite of autonomic signals, to detect noxious stimuli during propofol-remifentanil anesthesia. Anesthesiology. 2015; 123: 524–34.Google Scholar

Edry, R, Recea, V, Dikust, Y, Sessler, DI: Preliminary intraoperative validation of the Nociception Level Index: A noninvasive nociception monitor. Anesthesiology. 2016; 125: 193–203.Google Scholar

Luginbuhl, M, Schumacher, PM, Vuilleumier, P, Vereecke, H, Heyse, B, Bouillon, TW, Struys, MM: Noxious stimulation response index: a novel anesthetic state index based on hypnotic-opioid interaction. Anesthesiology. 2010; 112: 872–80.CrossRef Google Scholar PubMed

De Jonckheere, J, Delecroix, M, Jeanne, M, Keribedj, A, Couturier, N, Logier, R: Automated analgesic drugs delivery guided by vagal tone evaluation: interest of the Analgesia Nociception Index (ANI). Conf.Proc.IEEE.Eng.Med.Biol.Soc. 2013; 2013: 1952–5.Google Scholar