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Master Thesis

Effet de l’analgésie ciblée à objectif d’ANI (Analgesia/Nociception Index) pendant l’anesthésie générale sur la douleur postopératoire immédiate et l’hémodynamique peropératoire : protocole pour une étude multicentrique randomisée contrôlée

Abstract : Background: Severe postoperative pain remains a major problem that is seen in 20 to 40% of patients. The Analgesia/Nociception Index (ANI) is a 0-100 index reflecting the relative parasympathetic activity allowing for intraoperative analgesia monitoring. We have previously shown that an ANI value <50 immediately before extubation may predict the occurrence of immediate postoperative pain with good performance. We hypothesized that GOAL-Directed Analgesia may provide reduced immediate postoperative pain and optimized intraoperative remifentanil administration (GOLDAN study). Methods: The GOALDAN study is an international, multicenter, simple-blind, parallel, prospective, randomized, controlled, two-armed trial. Patients are randomly assigned in a 1:1 ratio in control group or in experimental group. Patients will be randomly allocated to either the intervention group (ANI) or the control group (standard care only). In the ANI group, the administration of remifentanil will be goal-directed targeting a 50-80 ANI range, with prophylactic injection of morphine immediately after extubation if case of ANI<50. Our primary objective was to determine whether the prophylactic administration of morphine at the end of the procedure in patients at risk of postoperative pain (ANI<50 immediately before extubation) could reduce the incidence of the latter by 50%. Our secondary objective was to determine whether the intraoperative use of goal-directed analgesia with an ANI target of 50 to 80 could improve intraoperative hemodynamics and postoperative outcome. Discussion: Because of the paucity of well-conducted trials, the authors believe that a randomized-controlled trial will improve the evidence for using analgesia monitoring during general anesthesia and strengthen current recommendations for intraoperative analgesia management.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03564207
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Submitted on : Thursday, February 10, 2022 - 11:42:05 AM
Last modification on : Saturday, February 12, 2022 - 3:46:24 AM
Long-term archiving on: : Wednesday, May 11, 2022 - 6:29:02 PM

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Adrien Michalot. Effet de l’analgésie ciblée à objectif d’ANI (Analgesia/Nociception Index) pendant l’anesthésie générale sur la douleur postopératoire immédiate et l’hémodynamique peropératoire : protocole pour une étude multicentrique randomisée contrôlée. Médecine humaine et pathologie. 2021. ⟨dumas-03564207⟩

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