Presented by: Ilona Pilosov Solomon MD
Department of Urology, Carmel Medical center

Introduction

Nociception Level (NoL) is a novel device developed to objectively quantify patient’s perceived pain in a non-invasive manner during surgeries performed under general anesthesia, combining patient’s autonomic signals to a single index. The higher the index the greater the pain perceived, and adequate pain control is defined between 10-25. 

Our aim was to evaluate NoL-guided opioid administration during laparoscopic and robotic urological surgeries. 

Materials

This is a single center randomized-prospective trial. All patients underwent robotic and laparoscopic radical prostatectomy, nephroureterectomy or partial nephrectomy, under propofol/remifentanil based anasthesia. The NoL index was recorded throughout all surgeries, remifentanil administration was based on the NoL index in the study group and based on hemodynamic parameters in the controls. The primary endpoint was intraoperative remifentanil administration and morphine doses in the post-anesthesia care unit (PACU), both adjusted to patient’s weight. Secondary endpoints were postoperative visual analogue scale (VAS) scores recorded 30 and 60 minutes after surgery. 

Results

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Twenty-three patients were included in final analysis. Median intraoperative NoL-index was 18 and 20 in NoL-guided and control groups, respectively (p=0.33). Mean remifentanil-adjusted-to-weight doses were 28.5 and 13.8 μg/kg in the study and control groups, respectively (p=0.35).

Mean 30 and 60-minute postoperative VAS scores were, 3 and 2 in the NoL-guided group vs. 4 and 3 in the control (p=0.26 and p=0.46, respectively). Morphine consumption during the PACU period was 0.01 mg/kg among NoL-patients and 0.02 mg/kg in the controls (p=0.17).

Conclusion

NoL index-guided antinociception points to better pain control needed in urologic laparoscopic and robotic surgery even though this did not currently translate to reduced postoperative pain and opiate consumption respect to hemodynamic-parameters based analgesia. 

Funding

Non

Lead Authors

Ilan Klein, MD
Department of Urology, Carmel Medical Center

Co-Authors

Michael Gretz, MD
Department of Anaesthesiology, Carmel Medical Center

Elad Attar, MD
Department of Anaesthesiology, Carmel Medical Center

Omar Ibrahim, MD
Department of Anaesthesiology, Carmel Medical Center

Amran Khalaila, MD
Department of Anaesthesiology, Carmel Medical Center

Yuval Friefeld, MD
Department of Urology, Carmel Medical Center

Rani Zreik, MD
Department of Urology, Carmel Medical Center

Zeev Goldik, MD
Department of Anaesthesiology, Carmel Medical Center

Yoram Dekel, MD
Department of Urology, Carmel Medical Center