A randomised controlled trial of the analgesia nociception index for intra‐operative remifentanil dose and pain after gynaecological laparotomy

Summary We aimed to investigate the effect of the analgesia nociception index on postoperative pain. We randomly allocated 170 women scheduled for gynaecological laparotomy and analysed results from 159: in 80 women, remifentanil was infused to maintain analgesia nociception indices 50–70; and in 79 women, remifentanil was infused to maintain systolic blood pressure < 120% of baseline values. The primary outcome was the proportion of women with pain scores ≥ 5 (scale 0–10) within 40 min of admission to recovery. The proportion of women with pain scores ≥ 5 was 62/80 (78%) vs. 64/79 (81%), p = 0.73. Mean (SD) doses of fentanyl in recovery were 53.6 (26.9) μg vs. 54.8 (20.8) μg, p = 0.74. Intra‐operative remifentanil doses were 0.124 (0.050) μg.kg −1 .min −1 vs. 0.129 (0.044) μg.kg −1 .min −1 , p = 0.55.