Analgesia nociception index (ani) monitoring in patients with thoracic paravertebral block: a randomized controlled study
Analgesia nociception index (ani) monitoring in patients with thoracic paravertebral block: a randomized controlled study
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DOI：
10.1007/s10877-017-0036-9
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发表时间：
2018-06-01
影响因子：
2.2
通讯作者：
Solak, Mine
中科院分区：
文献类型：
--
作者：
Dundar, Nurseda;Kus, Alparslan;Solak, Mine
本研究的目的是评价全麻下胸段椎旁阻滞（TPVB）乳腺手术患者术中镇痛伤害感受指数（ANI）监测的有效性。这项前瞻性随机试验是在获得伦理委员会批准后在44名计划在全身麻醉下接受乳房手术的患者中进行的。TPVB在术前期间使用20 mL T4水平的0.25%布比卡因进行。麻醉维持采用七氟烷O-2：空气混合液和瑞芬太尼输注。根据BIS监测调整术中七氟烷浓度，使数值保持在40-60之间。以随机方式将患者分为两组。对照组（n：22）根据血流动力学参数调整瑞芬太尼输注速率，ANI组（n：22）调整瑞芬太尼输注速率，使ANI监测值保持在50 ~ 70之间。瑞芬太尼总消耗量记录为微克。记录患者的人口统计学资料、麻醉和手术时间、术中血流动力学参数、麻醉后恢复时间和恢复药物中额外镇痛剂的需求。两组在人口统计学资料、术中血流动力学参数、麻醉后恢复时间和额外镇痛药物的需求方面无显著差异。两组间瑞芬太尼总消耗量存在统计学显著差异（ANI组：629.6 +/- 422.4 mcg，对照组：965.2 +/- 543.6 mcg）（p = 0.027）。在全麻患者中，ANI监测可以帮助优化阿片类药物的消耗，并提供术中伤害感受/抗伤害感受的数据，但需要进一步的大规模实验和临床试验。
The goal of the study was to evaluate the effectiveness of analgesia nociception index (ANI) monitoring during intraoperative period for patients with thoracic paravertebral block (TPVB) undergoing breast surgery under general anesthesia. This prospective randomized trial was performed after receiving ethics committee approval in 44 patients who were scheduled to undergo breast surgery under general anesthesia. TPVB was performed in the preoperative period using 20 mL of bupivacaine 0.25% at T4 level. Anesthesia maintenance was provided with sevoflurane in O-2: air mixture and remifentanil infusion. Intraoperative concentration of sevoflurane was adjusted according to BIS monitoring keeping the values between 40-60. In a randomized manner patients were divided into two groups. In Group control (n:22) intraoperative remifentanil infusion rate was regulated according to hemodynamic parameters, in Group ANI (n:22) remifentanil infusion rate was titrated to keep ANI monitoring values between 50-70. Total remifentanil consumption was recorded as micrograms. Demographic data, anesthesia and surgery time, intraoperative hemodynamic parameters, post-anesthesia recovery time and requirement of additional analgesic in the recovery drug were recorded. There were no significant difference in demographic data, intraoperative hemodynamic parameters, post-anesthesia recovery time and requirement of additional analgesic drug. There was a statistically significant difference between groups in total remifentanil consumption (Group ANI: 629.6 +/- 422.4 mcg, Group control: 965.2 +/- 543.6 mcg) (p = 0.027). In patients under general anesthesia ANI monitorisation can help optimisation of opioid consumption and provide data about nociception/antinociception intraoperatively but further experimental and clinical trials in a large scale are needed.