Effects of Intraoperative Nociception Monitoring during Adolescent Idiopathic Scoliosis Correction.
Florence Julien-Marsollier, Pierre Pardessus, Martin Lagarde et al.
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In 30 seconds
This multicenter randomized controlled trial evaluated whether Analgesia Nociception Index (ANI)-guided remifentanil administration during surgery for adolescent idiopathic scoliosis reduced postoperative morphine use. Among 244 randomized patients, day-1 morphine consumption was similar with ANI guidance and hemodynamic-guided care: median 0.4 [0.3; 0.8] vs 0.4 [0.3; 0.5] mg · kg -1, respectively (P = 0.93). ANI guidance reduced intraoperative remifentanil administration, but the trial found no differences in secondary outcomes, including persistent postoperative pain at 6 months.
Key findings
- Day-1 morphine consumption was similar between ANI and control groups: 0.4 [0.3; 0.8] vs 0.4 [0.3; 0.5] mg · kg -1 (P = 0.93).
- ANI guidance reduced intraoperative remifentanil administration by a mean 9.5 [4 to 15] μg ·kg -1 (P < 0.001).
- No differences were found in secondary outcomes, including persistent postoperative pain at 6 months.
Why it matters
Intraoperative nociception monitoring may alter opioid administration during surgery, but this trial did not show that ANI-guided dosing reduced postoperative morphine use in adolescents undergoing scoliosis correction. The distinction between reducing intraoperative remifentanil and changing postoperative opioid requirements is relevant when assessing monitoring strategies intended to improve perioperative opioid outcomes.