The bispectral index is a technique that involves assessing brain activity (through electroencephalography as well as electromyography), and has been proposed to be useful for the detection of pain among patients who are unable to communicate verbally. This review aimed to clarify whether the bispectral index is an appropriate tool to assess pain in the intensive care unit.

Objective. Pain assessment is a major challenge in nonverbal patients in the intensive care unit (ICU). Recent studies suggest a relationship between the Bispectral Index (BIS) and nociceptive stimuli. This study was designed to examine changes in BIS in response to experimental noxious stimuli. Methods. Thirty participants under general anesthesia were in this quasiexperimental, within subject, pre- and poststudy. In the operating room (OR), BIS was monitored during moderate and severe noxious stimuli, induced by a thermal probe on the participants' forearm, after induction of general anesthesia, prior to surgery. Results. Significant increases in BIS occurred during moderate (increase from 35.00 to 40.00, P = 0.003) and severe noxious stimuli (increase from 37.67 to 40.00, P = 0.007). ROC showed a sensitivity (Se) of 40.0% and a specificity (Sp) of 73.3% at a BIS value > 45, in distinguishing a moderate from a severe noxious stimuli. Conclusion. BIS increased in response to moderate and severe noxious stimuli. The Se and Sp of the BIS did not support the use of the BIS for distinction of different pain intensities in the context of deep sedation in the OR. However, the results justify further studies in more lightly sedated patients such as those in the ICU.