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Master Thesis

Monitorage du Nociception Level (NOL) index et consommation de morphiniques lors d’une chirurgie pour fracture de l’extrémité supérieure du fémur chez le sujet âgé : une étude rétrospective

Abstract : Introduction : the Nociception level (NOL) is a multiparametric monitoring tool for intraoperative nociception. Recently, a decrease in opioid consumption has been found using a NOL-guided anesthesia compared to standard management. This tool seems particularly suitable for the elderly subject, as the nociception-antinociception balance is difficult to assess and perioperative complications of opioid overdose are more frequent. The hypothesis of our study was that NOL monitoring would be correlated with a decrease in opioid consumption and the incidence of their side effects during hip surgery in patients over 75 years of age. Methods: we conducted a retrospective study in the emergency operating room of the University Hospital of Bordeaux. General anesthesia for hip fracture surgery in patients over 75 years was performed according to a standardized protocol. Intraoperative administration of remifentanil was adjusted according to the NOL value for the NOL+ group and the clinician assessment for the NOL- group. The primary outcome was the total dose of remifentanil during general anesthesia. Results: between February 2018 and January 2019, 18 patients were included in the NOL- group and 19 patients in the NOL+ group. There was no significant difference in the administration of remifentanil in the NOL+ group compared to the NOL- group (0.103 ± 0.02 µg.kg-1.min-1 for the NOL+ group compared to 0.104 ± 0.03µg.kg-1.min-1 p=0.94). There was a diminution of postoperative opioid consumption in the NOL+ group, but no difference in maximum pain score at 48 hours or adverse effects. A significant reduction in the administration of remifentanil was found throughout the study. Conclusion: NOL monitoring does not appear to decrease the intraoperative administration of remifentanil during anesthesia for hip fracture surgery in patients over 75 years of age. The lack of significant difference between the two groups could be explained in particular by the protocol effect observed during the study.
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Florian Piérot. Monitorage du Nociception Level (NOL) index et consommation de morphiniques lors d’une chirurgie pour fracture de l’extrémité supérieure du fémur chez le sujet âgé : une étude rétrospective. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02638119⟩

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