NoL Monitor Performances of Nociceptive and Non-nociceptive Stimuli Discrimination During Robotic Surgery (ROBOTNOL)
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|ClinicalTrials.gov Identifier: NCT04566536|
Recruitment Status : Completed
First Posted : September 28, 2020
Last Update Posted : June 13, 2022
Anesthesia quality and safety have improved over the past decades, thanks to improved monitoring devices. No nociception monitoring is currently part of the standard of care. Usually, hemodynamic parameters are used to evaluate nociception (heart rate, HR, and mean arterial pressure, MAP), but none of them are specific. However, nociception evaluation is critical. Indeed, where excess of nociception can lead to arterial hypotension and respiratory depression, insufficient nociception can lead to acute postoperative pain, which is followed by persistent chronic pain in 10-50% of patients. Different monitoring devices have been developed but none of them are still used in current practice. Recently developed, the nociception level (NoL) index (MEDASENSE BIOMETRICS Ltd®, Ramat Gan, Israel) is an index of nociception, based on a nonlinear algorithm combination of heart rate, heart rate variability, photoplethysmograph wave amplitude, skin conductance, skin conductance fluctuations, and their time derivatives.
Robotic surgeries have started to spread over the world 20 years ago, claiming to be mini-invasive with less hemorrhage complications, with better success based on the technical advantages of the robot allowing better access during anatomical challenges procedures. Robotic surgery has been suggested to decrease pain during surgery and post-operatively, because of the decreases abdominal wall constraints induced by the robotic arms compared to the surgeon arms.
This observational prospective non-interventional monocentric study intend to evaluate the performance of the NoL index to discriminate protocol-defined nociceptive from non nociceptive stimuli during robotic surgery.
All patients, scheduled for a robotic surgery procedure, will be orally informed about the study during the anesthesia consultation. During the procedure, the anesthesia procedure will be the same for all patients, as part of the usual care in our department. The NoL monitor will be added for the purpose of this study, but the results will be hidden from all physicians. All settings will be left the physician in charge. At the end of the surgical procedure, before transfer to the recovery room, data for the monitor will be extracted on a dedicated universal serial bus (USB) key. Files will be safely stored under RedCap before analysis.
|Condition or disease|
|Anesthesia Pain Management|
|Study Type :||Observational|
|Actual Enrollment :||83 participants|
|Official Title:||NoL Monitor Performances of Nociceptive and Non-nociceptive Stimuli Discrimination During Robotic Surgery Under Propofol-remifentanil Anaesthesia|
|Actual Study Start Date :||October 7, 2020|
|Actual Primary Completion Date :||April 22, 2022|
|Actual Study Completion Date :||April 22, 2022|
Patients ≥ 18 years old scheduled for robotic surgery (all specialties except ENT)
- NoL index validation [ Time Frame: 7 hours ]Area under the curve with the 95% confidence interval, based on the NoL absolute value after nociceptive and non-nociceptive stimuli.
- Discriminative diagnosis performance (nociceptive from non-nociceptive stimuli) of the heart rate after nociceptive and non-nociceptive stimuli. [ Time Frame: 7 hours ]Sensitivity, specificity and area under the curve
- Discriminative diagnosis performance (nociceptive from non-nociceptive stimuli) of the mean arterial pressure [ Time Frame: 7 hours ]Sensitivity, specificity and area under the curve of the mean arterial pressure after nociceptive and non-nociceptive stimuli.
- Discriminative diagnosis performance (nociceptive from non-nociceptive stimuli) of the BIS index [ Time Frame: 7 hours ]Sensitivity, specificity and area under the curve of the BIS index after nociceptive and non-nociceptive stimuli.
- Correlation between the NoL index and the mean arterial pressure during nociceptive stimuli [ Time Frame: 7 hours ]Spearman correlation test within the NoL index variations and the mean arterial pressure variations after each stimuli
- Correlation between the NoL index and the heart rate during nociceptive stimuli [ Time Frame: 7 hours ]Spearman correlation test within the NoL index variations and the heart rate variations after each stimuli
- Delay of the NoL index to detect a nociceptive stimuli [ Time Frame: 7 hours ]Delay between a NoL index above 25 and the nociceptive stimuli
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04566536
|Hôpital Bichat-Claude Bernard, AP-HP|
|Paris, France, 75877|
|Principal Investigator:||Aurélie GOUEL-CHERON, MD, PhD||Hôpital Bichat-Claude Bernard, AP-HP|