Pupillometry pain index decreases intraoperative sufentanyl administration in cardiac surgery: a prospective randomized study

Vivien Berthoud, Maxime Nguyen, Anouck Appriou, Omar Ellouze, Mohamed Radhouani, Tiberiu Constandache, Sandrine Grosjean, Bastien Durand, Isabelle Gounot, Pierre-Alain Bahr, Audrey Martin, Nicolas Nowobilski, Belaid Bouhemad, Pierre-Grégoire Guinot, Vivien Berthoud, Maxime Nguyen, Anouck Appriou, Omar Ellouze, Mohamed Radhouani, Tiberiu Constandache, Sandrine Grosjean, Bastien Durand, Isabelle Gounot, Pierre-Alain Bahr, Audrey Martin, Nicolas Nowobilski, Belaid Bouhemad, Pierre-Grégoire Guinot

Abstract

Pupillometry has proven effective for the monitoring of intraoperative analgesia in non-cardiac surgery. We performed a prospective randomized study to evaluate the impact of an analgesia-guided pupillometry algorithm on the consumption of sufentanyl during cardiac surgery. Fifty patients were included prior to surgery. General anesthesia was standardized with propofol and target-controlled infusions of sufentanyl. The standard group consisted of sufentanyl target infusion left to the discretion of the anesthesiologist. The intervention group consisted of sufentanyl target infusion based on the pupillary pain index. The primary outcome was the total intraoperative sufentanyl dose. The total dose of sufentanyl was lower in the intervention group than in the control group and (55.8 µg [39.7-95.2] vs 83.9 µg [64.1-107.0], p = 0.04). During the postoperative course, the cumulative doses of morphine (mg) were not significantly different between groups (23 mg [15-53] vs 24 mg [17-46]; p = 0.95). We found no significant differences in chronic pain at 3 months between the 2 groups (0 (0%) vs 2 (9.5%) p = 0.49). Overall, the algorithm based on the pupillometry pain index decreased the dose of sufentanyl infused during cardiac surgery.Clinical trial number: NCT03864016.

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Pupillary Pain Index algorithm.
Figure 2
Figure 2
Flow chart.
Figure 3
Figure 3
Evolution of sufentanyl site target. Time points: 2 min before orotracheal intubation (T1) 2 min before skin incision (T2); after sternotomy (T3); at the start of the CPB (T4); at CPB weaning (T5); at skin closure (T6).

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Source: PubMed

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