Effect of nociception level-directed analgesic management on opioid usage in robot-assisted laparoscopic radical prostatectomy: a single-center, single-blinded, randomized controlled trial

• Published in: Journal of anesthesia Vol. 38; no. 5; pp. 631 - 641
• Main Authors: Tanaka, Nobuhiro, Kadoya, Yuma, Suzuka, Takanori, Yamanaka, Takayuki, Ida, Mitsuru, Naito, Yusuke, Ozu, Naoki, Hori, Shunta, Kawaguchi, Masahiko
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.10.2024
• Subjects: Anesthesiology; Critical Care Medicine; Emergency Medicine; Intensive; Medicine; Medicine & Public Health; Original Article; Pain Medicine; Nociception; Anesthesia and analgesia; Opioid; Prostatectomy; Analgesics; Pain measurement
• ISSN: 0913-8668; 1438-8359; 1438-8359
• DOI: 10.1007/s00540-024-03365-x

Purpose To assess the importance of appropriate opioid administration methods according to nociceptive monitoring. Methods We conducted a randomized controlled trial involving 54 patients who underwent robot-assisted laparoscopic radical prostatectomy at our hospital. Patients were randomly allocated to either receive nociception level (NOL)-directed intraoperative opioid management with a minimum flow of remifentanil (NOL group) or conventional intraoperative analgesic management (control group). The primary outcome was the mean intraoperative remifentanil infusion flow rate (intraoperative remifentanil usage [μg]/ideal body weight [kg]/operation time [min]). The main secondary outcomes were plasma concentrations of three perioperative inflammatory biomarkers (interleukin-6, C-reactive protein [CRP], and cortisol levels) and postoperative pain (Numeric Rating Scale [NRS]) scores 2 h postoperatively and on postoperative days 1, 2, 3, and 7. Results Compared with standard analgesia management, NOL-directed analgesic management reduced remifentanil consumption by 20% ( – 0.038; 95% confidence interval, – 0.059 to – 0.017; p  = 0.0007). NOL-directed management did not lead to an increase in IL-6, CRP, or cortisol levels compared with conventional analgesic management. Furthermore, this protocol led to improvements in the NRS scores at rest 2 h postoperatively and upon movement up to postoperative day 3. Conclusion NOL-directed analgesic management reduced remifentanil consumption by 20% and the NRS scores at rest 2 h postoperatively and upon movement up to postoperative day 3 without an increase in inflammatory marker levels. Registry number Japan Registry of Clinical Trials, JRCTs052220034.