Untersuchung zur Wertigkeit des Analgesia Nociception Index (ANI) bei Hysterektomien im Hinblick auf den intraoperativen und postoperativen Analgetikabedarf

Bei dem Analgesia Nociception Index (ANI) handelt es sich um einen von aktuell mehreren sich auf dem Markt befindlichen Nozizeptionsmonitoren zur Erfassung der Sympathiko-va- galen-Balance. Im Falle des ANI erfolgt die Messung anhand der Analyse der Herzfre- quenzvariabilität (HRV) in Abhängigkeit v...

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Bibliographic Details
Main Author: Kunst, Anna Maria
Contributors: Wulf, Hinnerk (Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2021
Online Access:PDF Full Text
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The Analgesia Nociception Index (ANI) is one of several nociception monitors currently on the market for recording the sympathico-vagal balance. In the case of the ANI, the measure- ment is based on the analysis of heart rate variability (HRV) in dependence of breathing. The index is given in form of a dimensionless score between 0 and 100, where 0 stands for a lack of parasympathetic activity and 100 for a very strong parasympathetic activity. According to the manufacturer, a value between 50-70 under anesthesia corresponds to sufficient in- traoperative analgesia. In the present prospective, randomized, single center single-blind study on 110 hysterectomy patients, it was investigated whether the use of the ANI monitor for intraoperative analgesic control has an influence on intraoperative opioid consumption (fentanyl) and whether it has effects on postoperative pain (measured using the numerical rating scale in the post anaes- thesia unit), opioid-induced Side effects (shortness of breath, nausea and vomiting, reduced vigilance) and patient satisfaction with pain therapy. For this purpose, a total of 110 patients with an average age of 48 (± 9) years who underwent a laparoscopic hysterectomy were randomly divided into two homogeneous groups. The par- ticipants were blinded to their group membership. In both groups, the ANI was continuously recorded by the ANI monitor via an additional double electrode placed on the thorax during the entire course of anesthesia. In the intervention group (ANI group), the anesthetist could see the index value at all times and the analgesic therapy was based on this value. In the comparison group (VER group) the index was not visible and the analgesic therapy was car- ried out according to the anesthetist's assessment based on clinical vital parameters (blood pressure, heart rate), but in both cases always within the permissible dose limits according to the specialist information. In addition to the standard monitoring, the depth of anesthesia was also measured using the bispectral index (BIS), with a value between 40-60 being maintained. Bolus number and total amount of opioid consumption were documented. 73 Postoperatively, a pain score using the Numerical Rating Scala (NRS) as well as opioid- induced side effects and analgesic consumption were documented every 15 minutes in the post anesthesia care unit (PACU). On the third postoperative day, the patients on the ward were asked about side effects, pain and overall satisfaction. The data from both groups were then evaluated and compared with regard to total intraoper- ative consumption of fentanyl, pain score (NRS) and side effects in the post anesthesia care unit, as well as patient satisfaction. The aim of the study was to check whether the use of the ANI monitor leads to an optimization of the individual analgesic therapy in patients with laparoscopic hysterectomy compared to the usual clinical standard. Based on available studies in this area, a reduction in intraoperative opioid consumption was primarily assumed using the ANI. However, this could not be confirmed. Rather, our obser- vations showed a higher total intraoperative consumption of fentanyl in the intervention group, due to a significantly higher number of boluses. With regard to the secondary endpoints, there were hardly any differences between the groups, neither with regard to the pain score nor the side effects in the recovery room. Other studies have shown conflicting results in this regard. The patient survey on the 3rd postoperative day showed a difference in terms of the subjec- tively described reduction in vigilance, but not other side effects or overall satisfaction with the pain therapy. Comparative studies about satisfaction of patients are not available. In the present group of patients, the additional use of the ANI monitor for intraoperative con- trol of analgesic therapy in our clinic led to an increased consumption of fentanyl compared to the comparison group, without having an impact on the postoperative pain score, opioid- induced side effects or patient satisfaction. An optimization of pain therapy by intraoperative use of the Analgesia Nociception Index (ANI) monitor in hysterectomy patients under balanced anesthesia with sevoflurane and fen- tanyl could not be proven.