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Quantitative assessment of a pediatric nociception monitor in children under sevoflurane anesthesia
  1. Sebastien Lebrun1,2,
  2. Johanna Boccara1,
  3. Emeline Cailliau3,
  4. Mathilde Herbet4,
  5. Benoit Tavernier5,6,
  6. Isabelle Constant1,2 and
  7. Nada Sabourdin1,2
  1. 1Anesthesiology, CHU Armand Trousseau, GRC 29, Sorbonne University, APHP, Paris, France
  2. 2EA 7323: Pharmacologie et Evaluation des Thérapeutiques chez L’enfant et la Femme Enceinte, University of Paris, Paris, France
  3. 3Biostatistics, CHU Lille, Lille, France
  4. 4Research Unit CIC-IT 1403, CHU Lille, Lille, France
  5. 5Anesthesiology, CHU Lille, Pôle d’Anesthésie-Réanimation, Lille, France
  6. 6ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, University of Lille, Lille, France
  1. Correspondence to Dr Nada Sabourdin, Anesthesiology, Armand-Trousseau Hospital, Paris, France; nada.sabourdin{at}


Introduction Intraoperative monitoring of nociception has recently made substantial progress in adult anesthesia. In contrast, pediatric data are scarce. Newborn-Infant Parasympathetic Evaluation (NIPE index, Mdoloris Medical Systems, Loos, France) is the first nociception index specifically designed for young children. It is a dimensionless index comprised between 0 and 100. Two previous studies suggested that NIPE could indeed ‘detect’ nociception in anesthetized children. The objective of our study was to investigate if NIPE allowed to detect and to provide a quantitative assessment of nociception in children.

Methods Children were anesthetized with sevoflurane, and received a bolus of alfentanil (10 µg/kg before intubation). Before surgical incision, each participant received three tetanic stimulations (5 s, 100 Hertz) with a 5 min interval, in a randomized order: 10, 30 and 60 milliamps. NIPE and heart rate variations were assessed after each stimulation.

Results Thirty children (2.4±1.6 years) were included. Mean delay between alfentanil and the first stimulation was 19±4 min. Mean baseline NIPE was 75±10. NIPE variation after the stimulations was significant at 10, 30 and 60 mA (linear mixed regression model, p<0.001). The intensity of stimulation significantly influenced the amplitude of NIPE variation (linear mixed regression model p<0.001), but had no statistically significant effect on heart rate variation (p=0.52).

Discussion NIPE might allow a quantitative assessment of nociception in young children in these anesthetic conditions. This study provides a basis for future research investigating the potential benefits of NIPE-guided intraoperative analgesia in pediatric anesthesia.

Trial registration number NCT04381637.

  • pediatrics
  • pain measurement
  • technology
  • anesthesia, conduction

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors NS had the idea of the study, was responsible for study conception and design, participated in patient recruitment, data acquisition, data analysis, data interpretation. She wrote the article and revision. She is guarantor. SL was responsible for patient recruitement, data acquisition, he participated in data analysis and interpretation, drafting of the article and revision. JB was responsible for patient recruitment, data acquisition, she participated in data interpretation, critical revision of the manuscript. EC wrote the statistical plan, performed the statistical analysis, she participated in drafting of the manuscript and revision. MH was responsible for data management, she contributed to designing the study, data analysis, critical revision of the manuscript and revision. BT contributed to study conception and design, data analysis and interpretation, he was responsible for critical revision of the manuscript and revision. IC contributed to study conception and design, data analysis and interpretation, she was responsible for critical revision of the manuscript and revision. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

  • Funding This work was supported by the APICIL foundation and the French Society of Anesthesiology and Intensive care (SFAR).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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