Monitoring nociception —getting ‘ there yet’ might be easier with a road map

General anaesthesia can be described simplistically as a combination of hypnosis, anti-nociception and muscle relaxation. To allow a goal-directed approach to each component, validated and user-friendly monitoring solutions are essential. However, although the measurement of neuromuscular paralysis, as well as depth of anaesthesia, has been established for decades,12 the reliable assessment of (anti-)nociception appears to remain an elusive goal. The lack of such a tool is of specific interest as it relates to the current debate about the ideal (if any) doses of intraoperative opioids, because of the growing understanding of their potentially significant non-analgesic side-effects, such as immunosuppression.3 Traditionally, clinicians utilize symptoms of the physiological stress response to nociceptive stimuli (i.e. increase of heart rate, blood pressure or lacrimation) to guide analgesic administration. However, as the incidence of significant postoperative pain is still as high as 20 –80%,4 administration of intraoperative analgesics guided by clinical symptoms alone appears to be of very limited value for the prevention of acute postoperative pain.
Source: British Journal of Anaesthesia - Category: Anesthesiology Source Type: research