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Article

The Impact of Nociception Monitor-Guided Multimodal General Anesthesia on Postoperative Outcomes in Patients Undergoing Laparoscopic Bowel Surgery: A Randomized Controlled Trial

by
Satoshi Okamoto
†,
Hiroki Ogata
†,
Shohei Ooba
,
Ayano Saeki
,
Fumiya Sato
,
Kazunori Miyamoto
,
Mayu Kobata
,
Hiroai Okutani
,
Ryusuke Ueki
,
Nobutaka Kariya
and
Munetaka Hirose
*
Department of Anesthesiology and Pain Medicine, Hyogo Medical University Faculty of Medicine, Nishinomiya, Hyogo 663-8501, Japan
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2024, 13(2), 618; https://doi.org/10.3390/jcm13020618
Submission received: 27 December 2023 / Revised: 18 January 2024 / Accepted: 20 January 2024 / Published: 22 January 2024
(This article belongs to the Special Issue Anesthesia in General Surgery: Clinical Management and Challenges)
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Abstract

Background: Excess surgical stress responses, caused by heightened nociception, can lead to elevated levels of postoperative inflammation, resulting in an increased incidence of complications after surgery. We hypothesized that utilizing nociception monitor-guided multimodal general anesthesia would exert effects on postoperative outcomes (e.g., serum concentrations of C-reactive protein (CRP) after surgery, postoperative complications). Methods: This single-center, double-blinded, randomized trial enrolled ASA class I/II adult patients with normal preoperative CRP levels, scheduled for laparoscopic bowel surgery. Patients were randomized to receive either standard care (control group) or nociception monitor-guided multimodal general anesthesia using the nociceptive response (NR) index (NR group), where NR index was kept below 0.85 as possible. The co-primary endpoint was serum concentrations of CRP after surgery or rates of 30-day postoperative complications (defined as Clavien–Dindo grades ≥ II). Main Results: One hundred and four patients (control group, n = 52; NR group, n = 52) were enrolled for analysis. The serum CRP level on postoperative day (POD) 1 was significantly lower in the NR group (2.70 mg·dL−1 [95% confidence interval (CI), 2.19–3.20]) than in the control group (3.66 mg·dL−1 [95% CI, 2.98–4.34], p = 0.024). The postoperative complication rate was also significantly lower in the NR group (11.5% [95% CI, 5.4–23.0]) than in the control group (38.5% [95% CI, 26.5–52.0], p = 0.002). Conclusions: Nociception monitor-guided multimodal general anesthesia, which suppressed intraoperative nociception, mitigated serum concentrations of CRP level, and decreased postoperative complications after laparoscopic bowel surgery.
Keywords: C-reactive protein; inflammation; nociception; nociceptive response; postoperative complications C-reactive protein; inflammation; nociception; nociceptive response; postoperative complications

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MDPI and ACS Style

Okamoto, S.; Ogata, H.; Ooba, S.; Saeki, A.; Sato, F.; Miyamoto, K.; Kobata, M.; Okutani, H.; Ueki, R.; Kariya, N.; et al. The Impact of Nociception Monitor-Guided Multimodal General Anesthesia on Postoperative Outcomes in Patients Undergoing Laparoscopic Bowel Surgery: A Randomized Controlled Trial. J. Clin. Med. 2024, 13, 618. https://doi.org/10.3390/jcm13020618

AMA Style

Okamoto S, Ogata H, Ooba S, Saeki A, Sato F, Miyamoto K, Kobata M, Okutani H, Ueki R, Kariya N, et al. The Impact of Nociception Monitor-Guided Multimodal General Anesthesia on Postoperative Outcomes in Patients Undergoing Laparoscopic Bowel Surgery: A Randomized Controlled Trial. Journal of Clinical Medicine. 2024; 13(2):618. https://doi.org/10.3390/jcm13020618

Chicago/Turabian Style

Okamoto, Satoshi, Hiroki Ogata, Shohei Ooba, Ayano Saeki, Fumiya Sato, Kazunori Miyamoto, Mayu Kobata, Hiroai Okutani, Ryusuke Ueki, Nobutaka Kariya, and et al. 2024. "The Impact of Nociception Monitor-Guided Multimodal General Anesthesia on Postoperative Outcomes in Patients Undergoing Laparoscopic Bowel Surgery: A Randomized Controlled Trial" Journal of Clinical Medicine 13, no. 2: 618. https://doi.org/10.3390/jcm13020618

APA Style

Okamoto, S., Ogata, H., Ooba, S., Saeki, A., Sato, F., Miyamoto, K., Kobata, M., Okutani, H., Ueki, R., Kariya, N., & Hirose, M. (2024). The Impact of Nociception Monitor-Guided Multimodal General Anesthesia on Postoperative Outcomes in Patients Undergoing Laparoscopic Bowel Surgery: A Randomized Controlled Trial. Journal of Clinical Medicine, 13(2), 618. https://doi.org/10.3390/jcm13020618

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