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Analgesia Nociception Index (ANI) as a monitor of peri-operative nociception-antinociception balance in paediatric craniotomies: a prospective observational study

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Abstract

Introduction

Analgesia Nociception Index (ANI) as a monitor of peri-operative nociception-anti-nociception balance has not been studied in paediatric neurosurgery. The objectives were to study the correlation between ANI (Mdoloris Education system) and revised FLACC (r-FLACC) score for the prediction of acute postoperative pain in paediatric population undergoing elective craniotomies and to compare the changes in ANI values with heart rate (HR), mean arterial pressure (MAP) and surgical plethysmographic index (SPI) during various time points of intraoperative noxious stimulation and before and after opioid administration.

Methods

This prospective observational pilot study included 14 patients between 2 and 12 years of age undergoing elective craniotomies. HR, MAP, SPI, ANI instantaneous (ANIi) and ANI mean (ANIm) values were recorded intraoperatively and before and after opioid administration. Postoperatively HR, MAP, ANIi and ANIm, and pain scores (r-FLACC scale) were recorded.

Results

There was a statistically significant negative correlation between ANIi and ANIm with r-FLACC during the time course of PACU stay (r =  − 0.89, p < 0.001 and r =  − 0.88 and p < 0.001 respectively). Intraoperatively, in patients with ANIi values < 50, with additional fentanyl administration, there was an increasing trend in values beyond 50, which was statistically significant (p < 0.05) at 3, 4, 5 and 10 min. The trend in changes of SPI after opioid administration was not found to be significant for patients irrespective of the baseline SPI values.

Conclusion

The ANI is a reliable tool for objective assessment of acute postoperative pain as assessed by r-FLACC in children undergoing craniotomies for intracranial lesions. It may be used as a guide to nociception-antinociception balance during the peri-operative period in this population.

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Authors and Affiliations

  1. Department of Neuroanaesthesia and Neurocritical care, National Institute of Mental Health & Neurosciences (NIMHANS), 3rd floor Faculty Block, Hosur Road, Bangalore, 560029, India

    Prachi Sharma, Kondavagilu Ramaprasannakumar Shwethashri, Dhritiman Chakrabarti & Kadarapura Nanjundaiah Gopalakrishna

  2. Department of Neurosurgery, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, Karnataka, India

    Nishanth Sadashiva & Keyur Shah

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  1. Prachi Sharma
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Contributions

P. S.: methodology, data collection, writing—original draft, formal analysis, literature search; K. N. G. and K. R. S.: conceptualisation, methodology, writing—review and editing, supervision, project administration; D. C.: software, formal analysis, writing—review and editing; N. S.: data analysis, writing—review and editing; K. S.: data collection, literature search.

Corresponding author

Correspondence to Kadarapura Nanjundaiah Gopalakrishna.

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The study was approved by Institute Ethics Committee of the National Institute of Mental Health and Neurosciences and appropriate consent obtained before recruiting.

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381_2023_5905_MOESM1_ESM.docx

Supplementary file1 (DOCX 14 KB) Table S1: Descriptive statistics (mean ± standard deviation) of all the study variables across intra-operative study time points. ANIi = Analgesia nociception index instantaneous; ANIm = Analgesia nociception index mean; HR = Hear Rate; SBP = Systolic blood pressure; DBP = Diastolic blood pressure; MAP = Mean arterial pressure; SPI = Surgical plethysmographic index; T15,T30..T180 = Time in minutes after durotomy.

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Sharma, P., Shwethashri, K.R., Chakrabarti, D. et al. Analgesia Nociception Index (ANI) as a monitor of peri-operative nociception-antinociception balance in paediatric craniotomies: a prospective observational study. Childs Nerv Syst 39, 2169–2176 (2023). https://doi.org/10.1007/s00381-023-05905-4

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