Effect of analgesia nociception index monitor-based nociception control on perioperative stress responses during laparoscopic surgery in Trendelenburg position: a randomized controlled trial

Seung Hyun Kim; Chul Ho Chang; Jeong-Rim Lee; Seok Kyo Seo; Young In Kwon; Jae Hoon Lee

doi:10.3389/fmed.2023.1196153

Effect of analgesia nociception index monitor-based nociception control on perioperative stress responses during laparoscopic surgery in Trendelenburg position: a randomized controlled trial

Front Med (Lausanne). 2023 Aug 4:10:1196153. doi: 10.3389/fmed.2023.1196153. eCollection 2023.

Authors

Seung Hyun Kim¹, Chul Ho Chang¹, Jeong-Rim Lee¹, Seok Kyo Seo², Young In Kwon³, Jae Hoon Lee¹

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
² Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
³ Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Abstract

Introduction: The analgesia nociception index (ANI) monitor is a nociception monitoring device based on heart rate variability. We aimed to determine the effect of ANI monitor-based intraoperative nociception control on the perioperative stress response during laparoscopic surgery in the Trendelenburg position.

Methods: Altogether, 72 female patients who underwent total laparoscopic hysterectomy were randomized to either the control or ANI group. Intraoperative nociception was controlled by remifentanil administration in a conventional manner (based on blood pressure and heart rate) in the control group and by ANI monitoring in the ANI group. Perioperative stress responses were estimated by measuring the levels of serum catecholamines and catabolic stress hormones at three timepoints: after loss of consciousness, at the end of surgery, and 1 h after the end of surgery.

Results: The serum cortisol level at the end of surgery was significantly higher in the ANI group than in the control group (p < 0.001), although more remifentanil was administered in the ANI group than in the control group (p < 0.001). Changes in the other estimators' levels were comparable between groups during the perioperative period. The hemodynamic profiles during surgery were also significantly different between the two groups. Phenylephrine use to treat hypotension was more common in the ANI group than in the control group (p = 0.005). However, postoperative clinical outcomes such as pain and nausea/vomiting did not differ between groups.

Conclusion: ANI monitor-based nociception control in laparoscopic surgery in the Trendelenburg position did not improve perioperative stress responses, intraoperative opioid consumption, or postoperative clinical outcomes.Clinical trial registration: ClinicalTrials.gov (NCT04343638).

Keywords: analgesia; catecholamine; glucocorticoid; laparoscopy; nociception.

Associated data

ClinicalTrials.gov/NCT04343638