Ressources

The validity and applications of the analgesia nociception index: a narrative review.

Hum B, Bergese SD et al.

Front Surg. 2023 Aug 10;10:1234246. doi: 10.3389/fsurg.2023.1234246. eCollection 2023.PMID: 37638120

• The literature regarding ANI’s validity in reflecting nociception is mostly supportive both intra-operatively and in other clinical setting
• Additionally, applications of ANI have also been found to be useful in other settings and patient populations, such as in COVID-19, maternal, and septic patients

High-Frequency Heart Rate Variability Index: A Prospective, Observational Trial Assessing Utility as a Marker for the Balance Between Analgesia and Nociception Under General Anesthesia.

Anderson TA, De Jonckheere J. et al.

Anesth Analg. 2020 Apr;130(4):1045-1053. doi: 10.1213/ANE.0000000000004180.PMID: 31008745

• In adult subjects under general anesthesia for laparoscopic cholecystectomy, changes in the high-frequency HR variability index reflect alterations in the balance between nociception and analgesia
• This index might be used intraoperatively to titrate analgesia for individual patients

Effects of varying remifentanil concentrations on Analgesia Nociception Index under propofol: an observational study.

Susano MJ et al.

J Clin Monit Comput. 2021 Feb;35(1):199-205. doi: 10.1007/s10877-020-00457-3. Epub 2020 Jan 8.PMID: 31916221

• ANI was the only variable that positively correlated with the different remifentanil concentrations
• Our study showed that there was a significant decrease in Analgesia Nociception Index after a tetanic stimulation while hemodynamic and BIS parameters did not change, suggesting that the Analgesia Nociception Index may perform better than traditional hemodynamic parameters at reflecting noxious stimulation

Analgesia nociception index as a tool to predict hypotension after spinal anaesthesia for elective caesarean section.

Jendoubi A, et al.

J Obstet Gynaecol. 2021 Feb;41(2):193-199. doi: 10.1080/01443615.2020.1718624. Epub 2020 Mar 9.PMID: 32148136

• We have shown that the analysis of HRV with ANI was a predictor of maternal hypotension after spinal anaesthesia.

Changes of analgesia/nociception index under different surgical steps in abortion under general anesthesia: a prospective clinical study.

Xie H, et al.

.J Clin Anesth. 2020 Nov;66:109898. doi: 10.1016/j.jclinane.2020.109898. Epub 2020 Jun 23.PMID: 32590195

• The ANI values decreased significantly after the onset of surgical nociceptive stimuli (all P < .05 for the four surgical steps) and returned to the baseline level after completion of surgery.
• This observation implied that the de-cline in ANI values might be able to be used for predicting the occurrence of intraoperative movement. The multivariate logistic regression analysis showed that ANI was an independent factor associated with intraoperative movement

Guiding opioid-free intravenous antinociception with the Analgesia Nociception Index: a case report.

Coeckelenbergh S, et al.

J Anesthesiol. 2020 Nov-Dec;70(6):678-681. doi: 10.1016/j.bjan.2020.07.005. Epub 2020 Nov 7.PMID: 33279229

• Personalizing opioid-free antinociception with a nociception monitor is feasible. It may optimize intraoperative antinociception and improve postoperative comfort.

Management Based on Multimodal Brain Monitoring May Improve Functional Connectivity and Post-operative Neurocognition in Elderly Patients Undergoing Spinal Surgery.

Yang S, et al.

Front Aging Neurosci. 2021 Jul 15;13:705287. doi: 10.3389/fnagi.2021.705287. eCollection 2021.PMID: 34335234

• These results suggest that management of elderly patients undergoing surgery by multimodal brain monitoring may improve post-operative neurocognition and FC by reducing systemic inflammation
• Our results showed that management based on multimodal brain monitoring improved the post-operative cognitive function, as evidenced by the increased MoCA score.

Analgesia Nociception Index-Guided Remifentanil versus Standard Care during Propofol Anesthesia: A Randomized Controlled Trial.

Sabourdin N, et al.

J Clin Med. 2022 Jan 11;11(2):333. doi: 10.3390/jcm11020333.PMID: 35054027

• ANI guidance resulted in lower remifentanil consumption compared with standard practice under propofol anesthesia
• The proportion of patients reporting pain 3 months after surgery was 18.8% in the ANI group and 30.8% in the Standard group (difference = −12.0 (95% CI, −32.2 to 9.2))

Scoping review of the association between postsurgical pain and heart rate variability parameters.

So V, Balanaser M, et al.

Pain Rep. 2021 Dec 2;6(4):e977. doi: 10.1097/PR9.0000000000000977. eCollection 2021 Nov-Dec.PMID: 35155967

• Studies examined the association of postsurgical pain and HRV or analgesia nociception index derived from HRV. There was a statistically significant association between HRV measures and postsurgical pain in 6 of 8 studies.

Monitoring of analgesia level during general anesthesia in children.

Sabourdin N, Constant I.

Curr Opin Anaesthesiol. 2022 Jun 1;35(3):367-373. doi: 10.1097/ACO.0000000000001141.PMID: 35671026

• In summary, NIPE monitoring can detect nociception in anesthetized children aged less tan 2 years.
• In summary, ANI monitoring allows detection and quantification of intraoperative nociception in children older than 2 years.

Peri-operative multimodal monitoring: a real need or a luxury?

Moaiyeri Z, et al.

Clin Monit Comput. 2023 Apr;37(2):709-714. doi: 10.1007/s10877-022-00914-1. Epub 2022 Oct 22.PMID: 36271183

• The present case of a patient with several co-morbidities undergoing complex vitrectomy under peribulbar block and sedation with Target Controlled Infusion (TCI of propofol and dexmedetomidine with EEG and Analgesia Nociception Index (ANI) monitoring illustrates the benefits of multimodal monitoring to differentiate the effect of hypnotic and antinociceptive drugs.It is highlighted the delta-alpha electroencephalographic pattern showing adequate sedation, the beta arousal pattern in the EEG concommitant to decrease in the ANI translating insufficient anti-nociception.

 

Analgesia Nociception Index Monitoring in the Evaluation of Postoperative Pain in Children: A Prospective Observational Pilot Study.

Tiryaki Ö, et al.

J Perianesth Nurs. 2023 Apr;38(2):213-218. doi: 10.1016/j.jopan.2022.04.002. Epub 2022 Oct 12.PMID: 36241538 IF 1,3

• The ANI device can be used safely and constantly for the objective assessment of postoperative pain in pediatric patients.

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

Sharma P, et al.

Childs Nerv Syst. 2023 Aug;39(8):2169-2176. doi: 10.1007/s00381-023-05905-4. Epub 2023 Mar 4.PMID: 36869908

• 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.
• ANI may be used as a guide to nociception-antinociception balance during the peri-operative period in this population

Analgesia nociception index and high frequency variability index: promising indicators of relative parasympathetic tone.

Yoshida K, et al.

J Anesth. 2023 Feb;37(1):130-137. doi: 10.1007/s00540-022-03126-8. Epub 2022 Oct 22.PMID: 36272031

• In patients who cannot self-report pain, such as sedated patients, unconscious patients, or children, ANI can be useful in detecting the degree of pain and distress by setting the cutof value to around 50, which was also suggested by the manufacturer
• ANI may be able to predict postoperative pain in advance
• In all of these studies, ANI seems to be more sensitive in assessing nociception than heart rate or blood pressure. Thus, monitoring ANI during general anesthesia may reduce adverse cardiovascular events and improve the safety of anesthesia
• ANI has a certain usefulness as a nociception/pain monitor during or immediately after general anesthesia in patients undergoing surgery, and in severely ill patients in the ICU.
• ANI/HFVI has the potential to become a mainstream monitoring method in a next era, not just for nociception/pain monitoring, and further study of its use not only in the operative room and ICU

Maternal heart rate variability patterns associated with maternal hypotension and non-reassuring fetal heart rate patterns following initiation of combined spinal-epidural labor analgesia: a prospective observational trial.

Yang L, et al.

J Clin Monit Comput. 2023 Dec;37(6):1585-1591. doi: 10.1007/s10877-023-01044-y. Epub 2023 Jul 7.PMID: 37418059

• The ANI can predict the propensity for maternal hypotension and non-reassuring FHR patterns following CSE.
• The ANI yielded a more accurate ROC curve than conventional HRV analyses. This difference can be attributed to the utility of ANI as a sensitive index that reflects autonomic activity in seconds, without being affected by respiration or other factorsThese findings could help stratify women at a higher risk of adverse outcomes and may result in safer perinatal management.

Pain Assessment Using the Analgesia Nociception Index (ANI) in Patients Undergoing General Anesthesia: A Systematic Review and Meta-Analysis.

Kim MK, et al.

J Pers Med. 2023 Oct 4;13(10):1461. doi: 10.3390/jpm13101461.PMID: 37888072

• This systematic review and meta-analysis of 30 studies demonstrated that ANI monitoring during surgery can assist in predicting pain in patients during and after the surgical procedure. It also correlates with hemodynamic variables and a reduction in the use of intra-operative opioids during surgery.
• ANI monitoring can be useful for identifying the underlying causes of painless hypertension. Furthermore, it provides an additional advantage of preventing unnecessary opioid use that may occur based solely on hemodynamic monitoring.
• This systematic review and meta-analysis also showed ANI exhibited good performance for predicting post-operative pain. Although not included in the quantitative analysis, studies have indicated that ANI values not only reflect intra-operative nociception during surgery, but also post-operative pain.”

Analgesia-nociception index accurately predicts inadequate pectoralis muscle fascia block (PECS) in patients undergoing breast surgery: A prospective observational study.

Teng WN, et al.

J Formos Med Assoc. 2024 Mar 5:S0929-6646(24)00145-1. doi: 10.1016/j.jfma.2024.02.019. Online ahead of print.PMID: 38448346  IF 2.4

• The intraoperative ANI nadir <50 was strongly correlated with need for postoperative opioids.
• The ANI may aid in objectively evaluating the effectiveness of pectoralis muscle fascial blocks and predicting postoperative need for analgesics.

Predicting the optimal concentration of remifentanil for skull pin fixation with hemodynamic and analgesia nociception index monitoring.

Kuo YW, et al.

Sci Rep. 2024 Mar 18;14(1):6441. doi: 10.1038/s41598-024-56283-z.PMID: 38499567

• ANI monitoring is more sensitive on remifentanil requirement than hemodynamics and BIS during skull pin fixation.

ANI and BIS variations in supine and prone position during closed-tracheal suction in sedated and myorelaxed ICU patients with severe COVID-19: A retrospective study.

Boselli E, et al.

J Clin Monit Comput. 2021 Dec;35(6):1403-1409. doi: 10.1007/s10877-020-00612-w. Epub 2020 Nov 6.PMID: 33159268

• Monitoring ANI, but not BIS, may be of interest to detect noxious stimuli such as tracheal suction in ICU myorelaxed patients with severe COVID-19 pneumonia requiring prone positioning.
• Both ANIm and ANIi decreased significantly during tracheal suction with no difference between positions, whereas BIS showed no significant variation within time and between groups

 

Prospective multicenter study of heart rate variability with ANI monitor as predictor of mortality in critically ill patients with COVID-19.

Aragón-Benedí C, Caballero-Lozada AF, Perez-Calatayud AA, Marulanda-Yanten AM, Oliver-Fornies P, Boselli E, De Jonckheere J, Bergese SD; ANI-COVID-19 Research Group.

Sci Rep. 2022 Dec 16;12(1):21762. doi: 10.1038/s41598-022-25537-z.PMID: 36526646

• The ANIm value was higher (p = 0.013) and the Energy was lower in the deceased group (p = 0.001);
• Higher Energy was correlated with higher survival days (p = 0.009),
• Autonomic nervous system and heart rate variability monitoring in critically ill patients with COVID-19 allows for predicting survival days and 30-day mortality through the Energy value

 

Is the heart rate variability monitoring using the analgesia nociception index a predictor of illness severity and mortality in critically ill patients with COVID-19? A pilot study.

Aragón-Benedí C, et al.

PLoS One. 2021 Mar 24;16(3):e0249128. doi:10.1371/journal.pone.0249128. eCollection 2021.

• ANIm were higher in the non-survivor group (p = 0.003) and were correlated with higher IL-6 levels (p = 0.020).
• Energy was inversely correlated with SOFA (p = 0.039) and fewer survival days (p = 0.046).
• A limit value at 80 of ANIm, predicted mortalities with a sensitivity of 100% and specificity of 85.7%. In the case of Energy, a limit value of 0.41 ms predicted mortality with all predictive values of 71.4%.

 

Analgesia nociception index and high frequency variability index: promising indicators of relative parasympathetic tone.

Yoshida K, et al.

J Anesth. 2023 Feb;37(1):130-137. doi: 10.1007/s00540-022-03126-8. Epub 2022 Oct 22.PMID: 36272031

• In patients who cannot self-report pain, such as sedated patients, unconscious patients, or children, ANI can be useful in detecting the degree of pain and distress by setting the cutof value to around 50, which was also suggested by the manufacturer
• ANI may be able to predict postoperative pain in advance
• In all of these studies, ANI seems to be more sensitive in assessing nociception than heart rate or blood pressure. Thus, monitoring ANI during general anesthesia may reduce adverse cardiovascular events and improve the safety of anesthesia
• ANI has a certain usefulness as a nociception/pain monitor during or immediately after general anesthesia in patients undergoing surgery, and in severely ill patients in the ICU.
• ANI/HFVI has the potential to become a mainstream monitoring method in a next era, not just for nociception/pain monitoring, and further study of its use not only in the operative room and ICU

 

The validity and applications of the analgesia nociception index: a narrative review.

Hum B, Bergese SD, et al.

Front Surg. 2023 Aug 10;10:1234246. doi: 10.3389/fsurg.2023.1234246. eCollection 2023.PMID: 37638120

• The literature regarding ANI’s validity in reflecting nociception is mostly supportive both intra-operatively and in other clinical setting
• Additionally, applications of ANI have also been found to be useful in other settings and patient populations, such as in COVID-19, maternal, and septic patients

The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational With a Quasi-Experimental Pre/Posttest Methodology. Study

Alonso Puig M, et al.

J Med Internet Res. 2020 Mar 30;22(3):e16013. doi: 10.2196/16013.PMID: 32224482

• The use of EVGs in pediatric patients with chemotherapy-induced mucositis has a considerable analgesic effect, which is associated physiologically with an increase in parasympathetic vagal tone despite lower consumption of morphine
• The ANI parameters showed a statistically significant 14% increase in parasympathetic baseline tone on the day after playing the video games (mean value with vs without EVGs
• In this study, a 14% increase in the ANI was noted during the visit on the day after playing video games, suggesting that the beneficial effects of video games did not have a short duration but extended for several hours

 

End-of-life Comfort Evaluation, is Clinic Enough? A Retrospective Cohort Study of Combined Comfort Evaluation with Analgesia/Nociception Index and Clinic in non-Communicative Patients.

Bauschert L, Prod’homme C, et al.

J Palliat Care. 2024 Apr;39(2):122-128. doi: 10.1177/08258597211063687. Epub 2021 Nov 29.PMID: 34841971

• We suggest that the ANI monitor is a reliable tool in the palliative setting and may help provide patients with the best symptom relief and the most appropriate therapeutics.

 

Analgesia nociception index and high frequency variability index: promising indicators of relative parasympathetic tone.

Yoshida K, et al.

J Anesth. 2023 Feb;37(1):130-137. doi: 10.1007/s00540-022-03126-8. Epub 2022 Oct 22.PMID: 36272031

• In patients who cannot self-report pain, such as sedated patients, unconscious patients, or children, ANI can be useful in detecting the degree of pain and distress by setting the cutof value to around 50, which was also suggested by the manufacturer
• ANI may be able to predict postoperative pain in advance
• In all of these studies, ANI seems to be more sensitive in assessing nociception than heart rate or blood pressure. Thus, monitoring ANI during general anesthesia may reduce adverse cardiovascular events and improve the safety of anesthesia
• ANI has a certain usefulness as a nociception/pain monitor during or immediately after general anesthesia in patients undergoing surgery, and in severely ill patients in the ICU.
• ANI/HFVI has the potential to become a mainstream monitoring method in a next era, not just for nociception/pain monitoring, and further study of its use not only in the operative room and ICU

 

The validity and applications of the analgesia nociception index: a narrative review.

Hum B, et al.

Front Surg. 2023 Aug 10;10:1234246. doi: 10.3389/fsurg.2023.1234246. eCollection 2023.PMID: 37638120

• The literature regarding ANI’s validity in reflecting nociception is mostly supportive both intra-operatively and in other clinical setting
• Additionally, applications of ANI have also been found to be useful in other settings and patient populations, such as in COVID-19, maternal, and septic patients

Comparison of the Newborn Infant Parasympathetic Evaluation (NIPE) index to changes in heart rate to detect intraoperative nociceptive stimuli in healthy and critically ill children below 2 years: An observational study.

Neumann C, et al.

Paediatr Anaesth. 2022 Jul;32(7):815-824. doi: 10.1111/pan.14446. Epub 2022 Apr 5.PMID: 35332622

• The NIPE index was reliable for assessing intraoperative nociception in children aged <2 years and was more reproducible for detecting specific nociceptive stimuli during general anesthesia than heart rate.
• We found a significant association between decreasing NIPE index and defined intraoperative nociceptive stimuli, but heart rate did not reliably react to intraoperative nociception. The overall reproducibility of the NIPE index was high, both in healthy and deeply sedated, critically ill, already ventilated children.

 

Quantitative assessment of a pediatric nociception monitor in children under sevoflurane anesthesia.

Lebrun S, et al.

Reg Anesth Pain Med. 2022 Jun 2:rapm-2022-103547. doi: 10.1136/rapm-2022-103547. Online ahead of print.PMID: 35654480

• NIPE might allow a quantitative assessment of nociception in young children in these anesthetic conditions
• Age did not influence NIPE variation in response to nociception in our population.
• In this study, we included patients aged from 6 months to 6 years. Compared with the ANI algorithm,the NIPE algorithm was adapted in order to also include the higher heart rate and respiratory rate of 16 very young patients: the [0.15 – 0.4 Hz] window of analysis of the ANI was extended to a [0.15 – 3 Hz]window for the NIPE. Thus, although the NIPE® remains the only monitor specifically designed to assess heart rate variability in neonates and infants, it is also technically adequate for older children.

 

Monitoring of analgesia level during general anesthesia in children.

Sabourdin N, Constant I.

Curr Opin Anaesthesiol. 2022 Jun 1;35(3):367-373. doi: 10.1097/ACO.0000000000001141.PMID: 35671026

• In summary, NIPE monitoring can detect nociception in anesthetized children aged less tan 2 years.
• In summary, ANI monitoring allows detection and quantification of intraoperative nociception in children older than 2 years.

 

The Newborn Infant Parasympathetic Evaluation (NIPE™) monitor predicts post-operative pain in children undergoing day-procedures: A prospective observational study.

Ivanic S, et al.

J Pediatr Surg. 2023 Apr;58(4):684-688. doi: 10.1016/j.jpedsurg.2022.12.007. Epub 2022 Dec 22.PMID: 36646541

• The intraoperative NIPE index is predictive of pain in the immediate postoperative period
• our study is the first to show that intra-operative NIPE indices are significantly associated with FLACC scores within the first 10 min of arrival to the PACU.
• NIPEcould aid in standardising and optimising the pain management by identifying intraoperatively those neonates and infants at more risk of pain in the very early postoperative period.k