Nociception-Guided Opioids In Laparoscopic Endometriosis Surgery

Key Takeaways

• Perioperative opioid consumption was similar between NOL-guided analgesia and standard care within the standardized multimodal protocol.
• Postoperative pain scores were comparable at all reported time points, and no improvement in early postoperative outcomes was reported.
• Surgery duration was an independent predictor of opioid use and PACU length of stay, while higher preoperative Mankoski Pain Scale scores were associated with higher late-PACU pain.

In premenopausal women undergoing laparoscopic surgery for suspected endometriosis or adenomyosis, opioid use was similar with NOL-guided analgesia and standard care within a standardized multimodal regimen. The comparison tested whether device-guided titration could improve on routine clinical judgment when background analgesia was already standardized. The randomized trial analyzed 111 patients. NOL-guided titration did not lower perioperative opioid consumption versus clinical assessment alone, and early postoperative outcomes were also similar.

This prospective, randomized, single-blinded study assigned premenopausal women undergoing laparoscopic surgery for suspected endometriosis or adenomyosis to NOL-guided analgesia or standard care. All patients received a standardized multimodal analgesia protocol, and the analyzed groups included 54 patients in the NOL arm and 57 controls. Both approaches were evaluated within the same perioperative framework, keeping the comparison focused on opioid titration rather than background analgesic exposure. The primary outcome was total perioperative opioid consumption, and secondary outcomes were postoperative pain scores and PACU length of stay.

Detailed opioid comparisons were not significant, with adjusted mean differences of 14 μg for fentanyl and 52 μg for remifentanil. The between-group analysis yielded a p value of 0.8 for total perioperative opioid consumption. Postoperative pain scores were comparable between groups at all reported time points. NOL-derived metrics were also not associated with opioid consumption or postoperative pain, and treatment group was not a significant predictor in exploratory modeling. No measurable early perioperative advantage emerged for monitored opioid titration within the multimodal protocol.

Exploratory analyses identified surgery duration as an independent predictor of opioid use, with p less than 0.001, and of PACU length of stay, with p = 0.01. Higher preoperative Mankoski Pain Scale scores also independently predicted higher pain scores during the late PACU phase. These predictors were reported as exploratory associations rather than evidence that the monitored approach changed recovery trajectories. Within the standardized regimen, the monitored titration strategy did not add measurable early perioperative benefit.