The Analgesia Nociception Index: Tailoring Opioid Administration

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Opioids remain a cornerstone for perioperative analgesia, albeit frequently associated with side effects, most of them are dose dependent. Intraoperative opioid administration aims to blunt sympathetic-mediated response to nociception and is usually based on surrogate parameters such as tachycardia, hypertension, sweating, or movement. These symptoms have low sensitivity and specificity in detecting nociceptive stimuli, which can result in underdosage or overdosage of opioids administered during anesthesia. Misadministration of opioids contributes to increasing the incidence of side effects such as nausea, vomiting, respiratory depression, and opioid-induced hyperalgesia, the latter being of paramount importance, as it contributes to increasing postoperative pain and may initiate mechanisms responsible for chronic pain.1 These complications of nociception and its treatment lead to the need for additional information about nociception during surgery, which could help caregivers personalize the way they deliver opioid analgesia and hence increase the quality of care.
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