GOAL-Directed ANalgesia (GOALDAN)
GOAL-Directed ANalgesia (GOALDAN)
The primary purpose of GOALDAN study is to demonstrate the superiority of a targeted
 perioperative analgesic strategy by the ANI over the usual practice on the incidence of
 immediate postoperative pain.

 The investigators hypothesized that a prophylactic administration of morphine in patients
 with risk of postoperative pain determined by the ANI at the end of the intervention would
 reduce the incidence of immediate postoperative pain and that the targeted analgesia to ANI
 and minimal alveolar concentration (MAC) of desflurane could improve the perioperative
 hemodynamic, and the postoperative becoming.
Visits:

 -  The patient will arrive in the department the day before the surgical intervention
 (D-1). During this preoperative visit (D-1), the investigator

 -  will preselect potentially eligible patients

 -  will offer to participate to this study

 -  will give the notice form to the patients

 -  will present the research: objectives, benefits and constraints for the patients

 -  will check that patients understand the verbally administered Numeric Rating Scale
 (NRS) for the assessment of the postoperative This verbally administered NRS is
 routinely presented to all patients at a surgical intervention.

 -  The intervention day (D0):

 The investigator will collect the signed consent form after having ascertained the
 understanding of the notice form by the patient and checking the inclusion and non-inclusion
 criteria.

 The randomization will be done via the eCRF module (allocation group and number) and the
 preoperative data registration in the eCRF.

 • Surgical intervention (D0): All patients will receive a usual multimodal analgesia
 associating level 1 analgesics (acetaminophen, ketoprofen, nefopam) or level 2 (tramadol)
 administered 30 to 60 min before the foreseeable end of the surgical intervention. All
 patients will receive 0.1 to 0.2 mg/kg of morphine within the 30 min preceding the end of the
 surgical intervention according to the usual practice.

 Once the patient transferred to the recovery room, the assessment of the primary outcome
 (verbally administered NRS) will be done by the nurse responsible for the patient, when the
 patient arrives, during the stay and when the patient leaves the recovery room. If the
 verbally NRS > 3, a morphine titration by IV administration of 2 to 3 mg of morphine will be
 realised then the verbally NRS will be collected 5 min after, according to the usual
 practice. This morphine titration will continued until the obtaining of a verbal NRS ≤ 3.

 As an alternative to this morphine titration, where possible, a peripheral nerve block may be
 proposed to the patient and performed by the investigator to relieve the patient.

 If the patient is transferred directly in ICU without being extubated at the end of the
 intervention and so without transiting by the recovery room, the patient will be excluded
 from the study.
Inclusion Criteria:

 -  18≤ Age <65 years old

 -  Patient operated on a scheduled surgery under general anesthesia

 -  Patient with a American Society of Anesthesiologists (ASA) score of I to III

 -  Patient having given his consent in the manner described in Article L1122-1-1 of the
 Public Health Code

 -  Patient affiliated with a social security regimen or beneficiary of such a regimen

 Exclusion Criteria:

 -  general anesthesia without extubating (laryngeal mask)

 -  neuraxial preoperative regional anesthesia (epidural or rachianalgesia)

 -  opioid-free anesthesia

 -  preoperative peripheral nerve block with analgesic aim (infiltration of a local
 surgical anesthetic or transversus abdominis plane block-TAP block-authorized)

 -  arrhythmia or the presence of a pacemaker

 -  ambulatory surgery

 -  cardiac or cerebral surgery

 -  obstetrical surgery (caesarean)

 -  surgery performed with neuraxial regional anesthesia or peripheral anesthesia alone

 -  surgery performed in prone position

 -  urgent surgery

 -  endoscopic procedure or interventional radiology

 -  chronic pain treated with opiates

 -  expected surgery duration < 1h

 -  pathology of the autonomic nervous system (epilepsy, history of transient attack or
 stroke, paraplegia, hemiplegia, orthostatic hypotension, autonomic dysfunction)

 -  Patient with cardiogenic or septic shock

 -  Continuous infusion of vasoactive agents (ephedrine, phenylephrine, adrenaline, or
 noradrenaline)

 -  Postoperative transfer planned in intensive care unit (intubated patient) after
 surgery

 -  Person under tutorship or curatorship

 -  Pregnancy

 -  Breastfeeding