Journal of Pain Research (Dec 2021)
Exploration of a Multi-Parameter Technology for Pain Assessment in Postoperative Patients After Cardiac Surgery in the Intensive Care Unit: The Nociception Level Index (NOL)TM
Abstract
Céline Gélinas,1,2 Shiva Shahiri T,1,2 Melissa Richard-Lalonde,1,2 Denny Laporta,3,4 Jean-François Morin,5,6 Madalina Boitor,7 Catherine E Ferland,8,9 Patricia Bourgault,10 Philippe Richebé11 1Ingram School of Nursing, McGill University, Montreal, QC, Canada; 2Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital – CIUSSS West-Central Montreal, Montreal, QC, Canada; 3Faculty of Medicine, Respiratory Division, McGill University, Montreal, QC, Canada; 4Department of Medicine, Division of Adult Critical Care, Jewish General Hospital – CIUSSS West-Central Montreal, Montreal, QC, Canada; 5Faculty of Medicine, Department of Surgery, Division of Cardiac Surgery, McGill University, Montreal, QC, Canada; 6Department of Surgery, Cardiac Surgery, Jewish General Hospital – CIUSSS West-Central Montreal, Montreal, QC, Canada; 7Faculty of Dentistry, McGill University, Montreal, QC, Canada; 8Faculty of Medicine, Department of Anesthesia, McGill University, Montreal, QC, Canada; 9Shriners Hospitals for Children – Canada, Montreal, QC, Canada; 10Faculty of Medicine and Health Sciences, School of Nursing, Université de Sherbrooke, Sherbrooke, QC, Canada; 11Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital – CIUSSS de l’Est-de-l’Île-de-Montréal – Université de Montréal, Montreal, QC, CanadaCorrespondence: Céline GélinasIngram School of Nursing – McGill University, 680, Sherbrooke West, Suite 1800, Montreal, QC, H3A 2M7, CanadaTel +1 514 398 6157Fax +1 514 398 8455Email [email protected]: The aim of this study was to explore the use of a multi-parameter technology, the Nociception Level (NOL) index (Medasense Biometrics Ltd, Ramat Gan, Israel), for pain assessment in postoperative awake patients after cardiac surgery during non-nociceptive and nociceptive procedures in the intensive care unit (ICU).Materials and Methods: A prospective cohort repeated-measures design was used. Patients were included if they were in the ICU after undergoing cardiac surgery and if they could self-report their pain. A non-invasive probe was placed on the patient’s finger for the continuous monitoring of the NOL index. Patients’ self-reports of pain and anxiety (0– 10 Numeric Rating Scale or NRS), and behavioral scores with the Critical-Care Pain Observation Tool (CPOT) were obtained before and during a non-nociceptive procedure (ie, non-invasive blood pressure [NIBP] using cuff inflation), and before, during and after a nociceptive procedure (ie, chest tube removal [CTR]) for a total of five time points. Non-parametric tests were used to compare scores at different time points, and receiver operating characteristic curve analysis was performed.Results: Fifty-four patients were included in the analysis. The NOL index, pain and anxiety scores were significantly higher during CTR compared to rest and NIBP (p < 0.001). During CTR, the NOL was associated with self-reported pain intensity and unpleasantness but not with anxiety and CPOT scores. The NOL showed a modest performance in detecting pain (NRS ≥ 1 and ≥ 5) in this sample with sensitivity and specificity ranging from 61% to 85%.Conclusion: The NOL index was able to discriminate between a non-nociceptive and a nociceptive procedure and was associated with self-reported pain. Further validation testing of the NOL is necessary in a heterogeneous sample of ICU patients.Keywords: nociception, pain, pain assessment, adult, cardiac surgery, intensive care unit
