Nociception monitors vs. standard practice for titration of opioid administration in general anesthesia: A meta-analysis of randomized controlled trials

Dandan Ma; Jiahui Ma; Huayong Chen; Dongliang Mu; Hao Kong; Lingzhi Yu

doi:10.3389/fmed.2022.963185

Nociception monitors vs. standard practice for titration of opioid administration in general anesthesia: A meta-analysis of randomized controlled trials

Front Med (Lausanne). 2022 Aug 25:9:963185. doi: 10.3389/fmed.2022.963185. eCollection 2022.

Authors

Dandan Ma^{1

2}, Jiahui Ma³, Huayong Chen², Dongliang Mu³, Hao Kong³, Lingzhi Yu¹

Affiliations

¹ Department of Pain Management, Jinan Central Hospital, Shandong University, Jinan, China.
² Department of Anesthesiology, Yidu Central Hospital Affiliated to Weifang Medical University, Weifang, China.
³ Department of Anesthesiology, Peking University First Hospital, Beijing, China.

Abstract

Background: Nociception monitors are being increasingly used during surgery, but their effectiveness in guiding intraoperative opioid administration is still uncertain. This meta-analysis of randomized controlled trials (RCTs) aimed to compare the effectiveness of nociception monitors vs. standard practice for opioid administration titration during general anesthesia.

Methods: We searched the electronic databases of PubMed, EMBASE, Cochrane Library, Clinical Trial, and Web of Science from inception up to August 1, 2021, to identify relevant articles, and extracted the relevant data. Intraoperative opioid administration, extubation time, postoperative pain score, postoperative opioid consumption and postoperative nausea and vomiting (PONV) were compared between patients receiving nociception monitoring guidance and patients receiving standard management. The standardized mean difference (SMD), with 95% confidence interval (CI), was used to assess the significance of differences. The risk ratio (RR), with 95% CI, was used to assess the difference in incidence of PONV. Heterogeneity among the included trials was evaluated by the I ² test. RevMan 5.3 software was used for statistical analysis.

Results: A total of 21 RCTs (with 1957 patients) were included in the meta-analysis. Intraoperative opioid administration was significantly lower in patients receiving nociception monitor-guided analgesia than in patients receiving standard management (SMD, -0.71; 95% CI, -1.07 to -0.36; P < 0.001). However, pain scores and postoperative opioid consumption were not significantly higher in the former group. Considerable heterogeneity was found among the studies (92%). Extubation time was significantly shorter (SMD, -0.22; 95% CI, -0.41 to -0.03; P = 0.02) and the incidence of PONV significantly lower (RR, 0.78; 95% CI, 0.61 to 1.00; P = 0.05) in patients receiving nociception monitoring guidance.

Conclusions: Intraoperative nociception monitoring guidance may reduce intraoperative opioid administration and appears to be a viable strategy for intraoperative titration of opioids.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=273619, identifier: CRD42019129776.

Keywords: analgesia nociception index; general anesthesia; nociception; nociception monitors; opioid.

Publication types

Systematic Review