Observational studyJournal of clinical monitoring and computing2025
Utility of the nociception level index to monitor intraoperative nociception and predict acute postoperative pain in thoracic surgery.
Observational study in Journal of clinical monitoring and computing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Unlocking patient insights: a prospective study on patient reported outcome measures in thoracic surgery.Journal of cardiothoracic surgery · 2026Observational
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7 authors.
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Abstract
purposePostoperative pain remains a significant adverse event after thoracic surgery, to which intraoperative nociception contributes. To measure intraoperative nociception, the Nociception Level (NOL) monitor is one option. This study aims to assess the NOL's utility for measuring intraoperative nociception and predicting acute postoperative pain and opioid consumption.
methodsThis observational study included 114 thoracic surgery patients (37 thoracotomy, 77 minimally invasive surgery) utilizing two analgesic approaches (40 peridural anaesthesia, 74 intercostal nerve block). NOL's utility to monitor responses to incision and nerve block was assessed at population (Wilcoxon-signed-rank tests) and individual level (ROC-analyses). NOL's predictive utility for postoperative pain and opioid consumption was analysed at population (Mann-Whitney-U tests) and individual level (multivariable linear regression).
resultsPopulation NOL significantly increased after incision and decreased after nerve block (p < 0.01/ p < 0.01) and individual detection of nociception was significantly better than chance (AUCs: 0.68 [95%CI 0.61-0.75] / 0.62 [95%CI 0.53-0.72]). However, NOL did not differ significantly between thoracotomy and minimally invasive surgery (p = 0.12) or peridural anaesthesia and nerve block (p = 0.16), despite significantly different postoperative pain and opioid consumption (p < 0.01). Multivariable analyses showed no significant effect of NOL on postoperative pain or opioid consumption.
conclusionNOL captures intraoperative stress with an accuracy allowing to differentiate large nociception changes at both the population and individual level after skin incision and nerve block. However, NOL was unable to differentiate between patients with plausibly different nociception levels, like patients undergoing different surgical or analgesic techniques. Consequently, while NOL can detect large nociceptive changes, its current accuracy may be insufficient to reliably guide individual analgesia in clinical practice.
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