BACKGROUND To avoid underdosing or overdosing of analgesic medications, a variety of nociception monitors that use distinct techniques have been developed to quantify nociception during general anaesthesia. Although prior meta-analyses have examined the behaviour of nociception monitors vs standard care protocols, they did not include the potentially valuable data for monitor-to-monitor comparisons. In order to capture these data fully and compare the behaviour of these monitors, we conducted a systematic search and network meta-analysis. METHODS We performed a Bayesian network meta-analysis on data obtained from a systematic search within PubMed, Embase, Web of Science, Cochrane Library, and EmCare databases. The search was aimed to detect relevant RCTs on the use of nociception monitoring versus standard care or versus other nociception devices(s) during general anaesthesia in adult patients. The primary endpoint was intraoperative opioid consumption, for which we calculated the standardised mean difference (SMD) of morphine equivalents (MEs). Secondary endpoints included postoperative opioid consumption and nausea or vomiting, extubation time, postoperative pain score, and time to discharge readiness. The risk of bias was assessed using the revised Cochrane Risk of Bias tool for randomised trials (RoB 2.0). RESULTS Thirty-eight RCTs, including 3412 patients and studying five different types of nociception monitors, were included in the analyses: Nociception Level Monitor (NOL), Analgesia Nociception Index (ANI), Surgical Plethysmographic Index (SPI), Pupillometry (pupillary pain index [PPI] or pupil dilation reflex [PDR]), and the beat-by-beat cardiovascular depth of anaesthesia index (CARDEAN). Pupillometry showed a significant reduction in intraoperative opioid consumption compared with standard care (SMD -2.44 ME; 95% credible interval [CrI] -4.35 to -0.52), and compared with SPI (SMD -2.99 ME; 95% CrI -5.15 to -0.81). With respect to monitors other than pupillometry, no significant differences in opioid consumption were detected in comparison with standard care or other monitors. Pupillometry was associated with a longer time to discharge readiness from the PACU, whereas NOL was associated with shorter extubation times. No relevant differences in other secondary outcomes were found. CONCLUSIONS Apart from pupillometry, no monitors demonstrated a significant effect on intraoperative opioid consumption. Secondary outcomes indicate limited clinical benefit for patients when using these monitors.

中文翻译：

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全身麻醉期间不同监测仪测量伤害感受的比较：随机对照试验的网络荟萃分析。


背景 为避免镇痛药物剂量不足或过量，已经开发了各种使用不同技术的伤害感受监测器来量化全身麻醉期间的伤害感受。尽管先前的荟萃分析已经检查了伤害感受监测器与标准护理方案的行为，但它们不包括用于监测器与监测器比较的潜在有价值的数据。为了充分捕获这些数据并比较这些监测器的行为，我们进行了系统搜索和网络荟萃分析。方法 我们对从 PubMed、Embase、Web of Science、Cochrane Library 和 EmCare 数据库中系统检索获得的数据进行了贝叶斯网络荟萃分析。该检索旨在检测成年患者全身麻醉期间伤害感受监测与标准护理或其他伤害感受设备使用相关的随机对照试验。主要终点是术中阿片类药物消耗，为此我们计算了吗啡当量 （MEs） 的标准化均数差 （SMD）。次要终点包括术后阿片类药物消耗和恶心或呕吐、拔管时间、术后疼痛评分和出院准备时间。使用修订后的随机试验 Cochrane 偏倚风险工具 （RoB 2.0） 评估偏倚风险。结果 分析纳入了 38 项 RCT，包括 3412 名患者，研究了 5 种不同类型的伤害感受监测仪： 伤害感受水平监测仪 （NOL）、镇痛伤害感受指数 （ANI）、手术体积描记指数 （SPI）、瞳孔测量法 （瞳孔疼痛指数 [PPI] 或瞳孔扩张反射 [PDR]），以及逐次跳动心血管麻醉深度指数 （CARDEAN）。 瞳孔测量显示，与标准治疗 （SMD -2.44 ME;95% 可信区间 [CrI] -4.35 至 -0.52） 和 SPI （SMD -2.99 ME;95% CrI -5.15 至 -0.81） 相比，术中阿片类药物的消耗量显着减少。对于除瞳孔测量以外的监测器，与标准护理或其他监测器相比，未检测到阿片类药物消耗量的显着差异。瞳孔测量与 PACU 放电准备时间较长相关，而 NOL 与较短的拔管时间相关。未发现其他次要结局的相关差异。结论 除瞳孔测量外，没有监测仪显示对术中阿片类药物消耗有显着影响。次要结果表明，使用这些监护仪时，患者的临床益处有限。