Experiences with NeonFSC stress monitoring system for perioperative pain control in pediatric neurosurgery: a prospective observational study

Abstract

BACKGROUND: Prevention and treatment of pain is the primary goal of any anesthesiologist. This would entail meticulous assessment of pain, especially in children. However, there have been no comprehensive and objective methods developed to assess pain. Only a number of algometers based on the basic biology of the nociceptive system are currently used in clinical practice. OBJECTIVE: Our aim was to document and analyze the experience of using NeonFSC stress monitoring system (LLC «VKO Fiziomed», Russia) in clinical practice for perioperative pain control in pediatric neurosurgery. MATERIALS AND METHODS: We conducted a pilot prospective observational study that included 44 patients (18 girls and 26 boys) who were treated at the Burdenko National Medical Research Center for Neurosurgery at the age of 3 months to 18 years (Class I–II ASA). Patients received intraoperative fentanyl and postoperative administration of paracetamol round-the-clock and tramadol as needed. All patients underwent perioperative pain assessment using clinical data and pain assessment scales and the NeonFSC device. All patients were observed in the wake-up ward 3- minutes postextubation until transfer to the pediatric ward. Out of 44 patients, fourteen patients registered stress response in the NeonFSC monitoring system. Pain measured clinically using the Visual Analog Scale and FLACC were compared with NeonFSC data. RESULTS: No signs of prolonged insufficient analgesia were observed in any patient intraoperatively. The CSP index, an integral indicator of the patient’s status, demonstrated adequate level of anesthesia and analgesia during the operations (from 0 to 18 points). We demonstrated that the CSP index and clinical assessment of pain were concordant in 10 (71%) cases. Four of these children reported moderate pain and six showed mild pain. CONCLUSION: NeonFSC stress monitoring system is noninvasive and does not cause patient discomfort during recording. However, system indicators should be interpreted in the context of the overall clinical condition of the patient.