A brand new research has proven that efficient opioid-sparing anesthesia with dexmedetomidine could be guided with NOL ache monitoring expertise (Medasense, Israel). The research confirmed that the NOL monitor is ready to detect the impact of dexmedetomidine on the affected person’s ache response and allow administration of much less intraoperative opioids.
Sufferers present process anaesthesia for surgical procedures are historically handled with opioids (e.g., remifentanil) to handle intraoperative ache. However clinicians are progressively in search of to scale back opioid use by introducing multimodal analgesia, a way that entails a mixture of medicines that usually features a central alpha agonist, corresponding to dexmedetomidine.
This method might supply ache reduction, offset doubtlessly antagonistic results of particular person medication in bigger doses and allow a discount of opioid use throughout surgical procedure. With this technique, nevertheless, clinicians should not all the time in a position to predict whether or not the influence of the drug mixture will probably be efficient or extreme.
The present research addressed this problem in multimodal analgesia and examined its effectiveness by monitoring ache response (nociception) ranges in sufferers with the NOL monitoring system.
NOL monitoring is a non-invasive multi-sensor AI expertise that gives a dependable index to objectively detect and quantify the affected person’s physiological response to painful stimuli throughout anaesthesia, when sufferers cannot talk. This index guides the medical workforce in tailor-made ache treatment for every affected person. Earlier research have proven that the NOL index outperforms different indexes for monitoring of ache response to surgical stimuli and that NOL-guided analgesia has resulted in lowered intraoperative opioid consumption in addition to much less ache after surgical procedure.
Led by Dr. Sean Coeckelenbergh of Erasme College Hospital in Brussels, Belgium, the brand new randomised managed research examined 58 sufferers present process NOL-guided analgesia. Sufferers had been randomised to obtain both placebo or low-dose dexmedetomidine and each teams obtained intraoperative antinociception with a target-controlled infusion of remifentanil guided by the NOL index.
The research, simply revealed within the European Journal of Anaesthesiology, has proven that NOL can present an goal reflection of dexmedetomidine’s results, serving to the clinician within the decision-making course of when making use of multimodal ache reduction, with the potential for important opioid sparing throughout surgical procedure.
Multimodal anaesthesia has advantages, however it’s restricted in that we regularly have no idea the precise depth of anaesthesia and antinociception. The NOL index affords us a brand new solution to quantify nociception when combining alpha agonists and opioids.”
Dr Sean Coeckelenbergh, Erasme College Hospital
Coeckelenbergh, S., et al. (2021) Impact of dexmedetomidine on Nociception Stage Index-guided remifentanil antinociception. European Journal of Anaesthesiology. doi.org/10.1097/EJA.0000000000001402.