Pain monitoring in intensive care: How does the nociception level index affect treatment and prognosis? A randomized, controlled, double-blind trial/Yogun bakimda agri takibi: Nosisepsiyon duzeyi indeksi tedavi ve prognozu nasil etkiler? Randomize kontrollu, cift kor bir calisma

• Published in: Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES Vol. 30; no. 6; p. 415
• Main Authors: Caliskan, Berna, Besir, Zeki, Sen, Oznur
• Format: Journal Article
• Language: English
• Published: KARE Publishing 01-06-2024
• Subjects: Analgesics; Anesthesia; Care and treatment; Delirium; Medical research; Medicine, Experimental; Pain; Prognosis
• ISSN: 1306-696X

BACKGROUND: Effective pain management is vital in critical care settings, particularly post-surgery. Clinicians should maintain objective and efficient standards to assess pain in a patient-centered manner, in order to effectively manage this complex issue. A newer technology, the nociception level (NOL) index, shows promise in achieving this task through its multi-parameter evaluation. METHODS: Th is study was a prospective, controlled, randomized trial involving two groups of patients (n=30 each) in a diverse intensive care unit. Participants were over 18 years old with American Society of Anesthesiology scores ranging from I to III and were scheduled for critical care follow-up after general anesthesia. All subjects followed a standard analgesia protocol that included rescue analgesia. Drug administration was guided by a numeric rating scale and the critical care pain observation tool in the Control Group, while it was guided by nociception level index monitoring in the NOL Group. RESULTS: Pain scores between the two groups did not significantly differ. However, within the NOL Group, pain scores and nociception values displayed a strong positive correlation. Notably, total analgesic consumption was significantly lower in the NOL Group (p=0.036). CONCLUSION: Monitoring pain using the nociception level index is an effective method for detecting pain compared to standard pain scores utilized in critical care. Its guidance facilitates personalized analgesic titration. Additionally, the potential of nociception level index guidance to reduce the duration of intensive care and hospital stays may be linked to its effects on delirium, a connection that awaits further exploration in future studies. Keywords: Behavioral pain scores; delirium; nociception level index; pain monitoring; postoperative cognitive dysfunction; postoperative pain. AMAC: Ozellikle ameliyat sonrasi yogun bakimda agri yonetimi onemlidir. Bu cok boyutlu sorunu yonetmek icin klinisyenlerin agriyi hasta bazli bir sekilde tespit etmeye yonelik objektif ve etkili standartlar saglamalari gerekir. Yeni bir teknoloji olan nosisepsiyon duzeyi indeksi, gok parametreli degerlendirmesiyle bu gorevi basarmak icin umut verici bir adaydir. GEREC VE YONTEM: Heterojen yogun bakim unitesindeki iki grubu (n=30) karsilastirmak icin prospektif, kontrollu, randomize bir galisma tasarlandi. Genel anestezi sonrasi yogun bakim takibi icin 18 yas ustu ve Amerikan Anesteziyoloji Dernegi skoru I-III olan hastalar segildi. Tum hastalara, kurtarma analjezisini de igeren standart analjezi protokolu verildi ve ilag uygulamasi, Grup NOL'de nosisepsiyon duzeyi indeksi monitorizasyonu tarafindan yonlendirilirken Grup Kontrol'de sayisal bir derecelendirme olgegi ve kritik bakim agri gozlem araci tarafindan yonlendirildi. BULGULAR: Agri skorlari agisindan gruplar arasinda anlamli fark yoktu. NOL Grubu igindeki agri skorlari ve nosisepsiyon degerleri guglu bir pozitif korelasyon gosterdi. Toplam analjezik tuketimi NOL grubunda anlamli derecede dusuktu (p=0.036). SONUC: Agri igin nosisepsiyon duzeyi indeksinin izlenmesi, yogun bakimda kullanilan standart agri skorlariyla karsilastirildiginda agriyi tespit etmenin etkili bir yoludur. Rehberliginde kisisellestirilmis analjezik titrasyonuna yardimci olur. Nosisepsiyon duzeyi indeksinin yogun bakim ve hastanede kalis suresini azaltma uzerindeki etkisi, daha fazla calisma ile ortaya cikarilmayi bekleyen deliryum uzerindeki etkisiyle baglantili olabilir. Anahtar sozcukler: Agri takibi; davranissal agri skorlari; deliryum; nosisepsiyon duzeyi indeksi; postoperatif bilissel islev bozuklugu; postoperatif agri.