Nociception level-guided opioid administration in radical retropubic prostatectomy: a randomised controlled trial

Area of Science:

• Anesthesiology
• Pain Management
• Medical Devices

Background:

• Randomized controlled trial (RCT) evaluating opioid titration during general anesthesia.
• Comparison of three nociception monitoring devices against clinical judgment.
• Focus on patients undergoing radical retropubic prostatectomy.

Purpose of the Study:

• To investigate the effect of opioid titration guided by nociception monitoring devices versus clinical signs.
• To determine differences in intraoperative remifentanil requirements.
• To assess recovery parameters and stress hormone levels.

Main Methods:

• 96 patients randomized into four groups: control (clinical judgment), surgical pleth index (SPI), pupillary pain index (PPI), and nociception level (NOL).
• Propofol/remifentanil anesthesia used.
• Primary endpoint: intraoperative remifentanil requirement; secondary endpoints: recovery and cortisol levels.

Main Results:

• Significant differences in remifentanil administration rates across groups (P<0.001).
• PPI group showed the lowest remifentanil use (0.07 μg kg⁻¹ min⁻¹) and highest cessation rate (75.0%).
• Cortisol levels differed significantly between groups, with PPI and NOL showing higher levels than control (P<0.001 and P=0.001, respectively).

Conclusions:

• Nociception monitoring devices and clinical signs reflect nociception differently, impacting remifentanil dosing.
• Opioid doses influenced serum cortisol concentrations.
• Further validation of nociception monitoring devices for intraoperative opioid guidance is required.