Effect of Dexmedetomidine on Nol-Index Guided Remifentanil Analgesia

Effect of Dexmedetomidine on Nol-Index Guided Remifentanil Analgesia

Publication date: Apr 11, 2019

Background: Analgesia remains to this day a challenge for anesthesiologists. Dexmedetomidine, a potent central alpha-2 agonist, has been shown to have analgesic and opioid sparing effects. The classic analgesic strategy focuses on opioid administration guided by estimated time of elimination and hemodynamic response (increase in blood pressure and heart rate). This technique is not sensitive and forces the anesthesiologist to be one step behind nociception, the patient’s unconscious response to pain. PMD-200 (Medasense, Israel) displays the Nociceptive level (NOL)-Index as marker of nociception. The NOL-Index ranges from 0 (no nociception) to 100 (intense nociception) and the recommended analgesic range during surgery is from 10 to 25 (Medasense recommendations). The goal of this study is to compare two analgesia strategies guided by the NOL Index (range 10-25) using either remifentanil TCI (target controlled infusion) alone or remifentanil TCI associated with a continuous dexmedetomidine infusion. Methods: A total of 100 patients will be included and informed consent will be acquired. This bi-center study will take place at Erasme University Hospital (primary center) and Saint-Pierre University Hospital. Patients will be randomized into either two groups: remifentanil and placebo versus remifentanil and dexmedetomidine. Both groups will be monitored using the PMD-200 that will guide the analgesic therapy strategy. Investigators and patients will be blinded to dexmedetomidine and placebo administration. The primary outcome will be intraoperative remifentanil consumption. Secondary outcomes will include postoperative opioid administration, opioid associated complications, hemodynamics, and hospital length of stay.

Concepts Keywords
Agonist Preoperative organ dysfunction
Analgesia Pain
Analgesic Nose throat surgery
Anesthesiologist Chemical compounds
ASA Organic compounds
Blood Pressure Psychoactive drugs
Cardiac Rhythm Opioids
Cervical Imidazoles
Heart Rate Fentanyl
Hemodynamic General anesthetics
Hemodynamics Piperidines
Hospital Remifentanil
Informed Consent Dexmedetomidine
Infusion Analgesic
Intraoperative
Israel
Lactation
Nociception
Nociceptive
NOL
Opioid
Organ
Pacemakers
Pain
Placebo
Plastic
TCI

Semantics

Type Source Name
drug DRUGBANK Dexmedetomidine
drug DRUGBANK Remifentanil
disease DOID Analgesia
gene UNIPROT PTPN5
disease DOID PMD
gene UNIPROT PLP1
gene UNIPROT LXN
gene UNIPROT TCN1
disease MESH complications
drug DRUGBANK Acetylsalicylic acid
gene UNIPROT ARSA
disease MESH Allergy
disease DOID Allergy
gene UNIPROT NR4A2
gene UNIPROT ALG3
disease MESH Postoperative Complications

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