翻译：佟睿 编辑：冯玉蓉 审校：曹莹
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%)。
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
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.