What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension undergoing laparoscopic cholecystectomy (n=49). Intervention: Preoperative β-blocker use vs. Non-β-blocker use. Primary outcome: Inter-group difference in minimum Analgesia-Nociception Index (ANI_min) in response to standardized nociceptive stimuli.

What question did this study set out to answer?

This research aims to determine if preoperative β-blocker use influences the Analgesia-Nociception Index during laparoscopic cholecystectomy.

June 19, 2026Open Access

Effect of preoperative β-blocker use on Analgesia–Nociception Index during laparoscopic cholecystectomy

JBJoon-suk BomChonnam National University Hospital SLSeongheon LeeChonnam National University Hospital YYY H YooSeoul National University

Key Result

Preoperative β-blocker therapy did not substantially alter stimulus-related Analgesia-Nociception Index dynamics during laparoscopic cholecystectomy under propofol-remifentanil anesthesia.

Key Points

This research aims to determine if preoperative β-blocker use influences the Analgesia-Nociception Index during laparoscopic cholecystectomy.
Analyzed data from 49 patients with hypertension undergoing elective laparoscopic cholecystectomy.
Patients were categorized into β-blocker (n=24) and non-β-blocker (n=25) groups.
Applied nociceptive stimuli and assessed ANI_min and ΔANI using repeated-measures ANOVA.
Significant reduction in ANI was observed in response to nociceptive stimuli (p<0.05).
No significant differences in ANI_min or ΔANI between β-blocker and non-β-blocker groups.
ANI changes were consistent between both groups across predefined time points.

Study Design

Type

Observational (n=49)

Multicenter

Structured PICO

Does preoperative β-blocker use alter intraoperative Analgesia-Nociception Index (ANI) dynamics during laparoscopic cholecystectomy?

Population

49 adult patients aged 18-65 years with hypertension undergoing elective laparoscopic cholecystectomy, evaluated for intraoperative autonomic responses based on chronic β-blocker use.

Exposure

Chronic β-blocker use

Comparator

Non-β-blocker use

Outcome

Minimum Analgesia-Nociception Index (ANI) value within 2 min after each stimulus (ANI_min) and the change from the pre-stimulus value (ΔANI)surrogate

Preoperative β-blocker therapy does not substantially alter stimulus-related Analgesia-Nociception Index dynamics during laparoscopic cholecystectomy under propofol-remifentanil anesthesia.

Limitations

Single-center observational study without randomization, leaving potential for residual confounding and selection bias
Higher ASA physical status in the β-blocker group and exclusion of patients requiring vasoactive agents may limit generalizability
Relatively small sample size, potentially underpowered to detect subtle differences in ANI responses
Lack of detailed data on remifentanil exposure and β-blocker therapy specifics (dose, duration, timing)
ANI was assessed without comparison to other nociception monitoring modalities or postoperative clinical outcomes
Findings may not be generalizable to opioid-free or enhanced sympatholytic anesthetic strategies

Abstract

Background The Analgesia-Nociception Index (ANI), derived from heart rate variability, reflects parasympathetic activity and is used to assess intraoperative nociception. β-blockers modulate autonomic tone and heart rate variability and may influence responses to nociceptive stimuli. This study investigated whether preoperative β-blocker use was associated with altered intraoperative ANI dynamics during laparoscopic cholecystectomy. Method The data of 49 patients with hypertension who underwent elective laparoscopic cholecystectomy under a standardized propofol-remifentanil anesthetic protocol were analyzed in this prospective observational study. Patients were classified according to chronic β-blocker use (β-blocker group, n = 24; non-β-blocker group, n = 25). Four predefined nociceptive stimuli were applied under stable anesthetic conditions. The minimum ANI value within 2 min after each stimulus (ANIₘin) and the change from the pre-stimulus value (ΔANI) were analyzed using repeated-measures analysis of variance. Results Repeated-measures ANOVA demonstrated a significant main effect of time, indicating a consistent decrease in ANI in response to standardized nociceptive stimuli. No significant time × group interaction or main effect of group was observed for ANIₘin or ΔANI. The temporal patterns and magnitudes of ANI changes were comparable between groups across all predefined time points. Conclusions Preoperative β-blocker therapy did not substantially alter stimulus-related ANI dynamics during laparoscopic cholecystectomy under propofol-remifentanil anesthesia. These findings suggest that ANI may remain interpretable as a dynamic within-patient autonomic response in chronically β-blocked patients under these anesthetic conditions.

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