Analgesia Nociception Index: an Evidence-Based Review

Main Article Content

Prok Laosuwan


The aims of general anesthesia consisted of
unconsciousness, immobility and analgesia. One of the
main analgesic drugs is opioids which are usually titrated
by clinical surrogates of nociception and experiences of
health care providers. The under-dosage or over-dosage
of intraoperative analgesia could occur, resulting in
nausea, vomiting, respiratory depression and opioidinduced
hyperalgesia. Nociception is not a subjective
feeling but the whole physiological process of nociceptive
stimuli. The new non-invasive objective tools, Analgesia
Nociception Index (ANI), has been developed to achieve
objective pain assessment during intraoperative or patients
who unable to communicate. ANI measures heart rate
variability from EKG monitoring. The results are
continuously showed as a number from 0 to 100 through
spectral analysis. The number indicates the balance
between parasympathetic and sympathetic outflows. Most
of studies exhibited favorable results in patients under
anesthesia in terms of decreased dose of intraoperative
opioids and good correlation with hemodynamic reactivity.
However, the overall expected benefits including better
postoperative pain scores correlation or less undesirable
adverse events of opioids were until questionable. There
are some limitations of use and confounding factors that
might interfere with interpretation.

Article Details

Review articles


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