Objective monitoring of nociception: a review of current commercial solutions

Abstract

Nociception, in contrast to pain, is not a subjective feeling, but the physiological encoding and processing of nociceptive stimuli. However, monitoring nociception remains a challenge in attempts to lower the incidence of acute postoperative pain and the move towards a more automated approach to analgesia and anaesthesia. To date, several commercialised devices promise a more accurate reflection of nociception than the traditionally used vital signs, blood pressure and heart rate. This narrative review presents an overview of existing technologies and commercially available devices, and offers a perspective for future research. Although firm conclusions about individual methods may be premature, none currently appears to offer a sufficiently broad applicability. Furthermore, there is currently no firm evidence for any clinically relevant influence of such devices on patient outcome. However, the available monitors have significantly aided the understanding of underlying mechanisms and identification of potential pitfalls.

Keywords: analgesia; nociception; nociception index; nociceptive flexion reflex; pupillometry; skin conductance; surgical pleth index.

Conflict of interest statement

The author has received travel grants, speaker fees, or honoraria for consultation from GE Healthcare, Mdoloris Medical Systems, MedStorm Innovations, and Philips. However, none of the aforementioned companies nor any other third party had an influence on this review.

Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.