<p>Prediction of Postoperative Pain and Opioid Consumption Using Intraoperative Surgical Pleth Index After Surgical Incision: An Observational Study</p>

Abstract

Background: We evaluated whether the surgical pleth index (SPI) following surgical incision was related to postoperative pain and opioid consumption. Methods: This prospective observational study was performed in 50 patients undergoing laparotomy under sevoflurane-based general anesthesia. We recorded the highest SPI during surgical incision. The postoperative pain with a numerical rating scale (NRS) and opioid consumption during postoperative 24 h were compared in patients who showed SPI over 50 (Group H) or 20-50 (Group L). The relationship between postoperative opioid consumption and SPI values (pre-incision, post-incision SPI value, change of SPI value, and post-incision SPI minus pre-incision SPI) was evaluated using receiver-operating characteristic analysis. Results: The mean of the highest SPI value during surgical incision was 56 (SD, 12; range, 26-85). Twenty-nine (63%) patients were included in Group H and 17 (37%) patients in Group L. There was a significant difference in NRS during recovery room stay and on postoperative 24 h in two groups (5 [5, 6] vs 7 [6, 8], p=0.007 and 3.5 [3, 5] vs 5 [5,6], p=0.006, Group L vs Group H). Group H used higher fentanyl via patient control analgesia during postoperative 24 h (573 (253) µg vs 817 (305) µg, p=0.008). A change of pre-incision and post-incision SPI value of 23, which showed the highest sensitivity (67%) and specificity (68%), was defined post hoc as the cutoff for fentanyl consumption during postoperative 24 h ≥1000 µg. Conclusion: Our finding suggests that the SPI response to nociceptive stimuli during surgery is closely related to the degree of patient postoperative pain and opioid requirements. This information may be used to provide proper intraoperative analgesia and individual postoperative pain management.

Predictive value of EEG-derived pain threshold index for acute postoperative pain in children

“…It is well-known that SPI derived from the analysis of the plethysmographic pulse wave amplitude and interval could reflect the different levels of autonomous nerve system activation, which is often caused by pain stimulation. Mounting studies have shown that SPI has the potential to reflect intraoperative noxious stimulation and guide the administration of opioids in adult patients ( 10 , 11 ), and the cut-off value of 50 was used to distinguish between mild and moderate-to-severe pain ( 12 ). However, different from adult patients, the study by Ledowski et al showed that the cut-off value of SPI 50 may be too high to predict acute postoperative pain in children, and its use in children may cause more postoperative agitation and fentanyl consumption ( 13 ).…”

Adequacy of Anaesthesia for Nociception Detection during Vitreoretinal Surgery

“…In addition, in 2013, Gruenewald et al [ 5 ] proposed a ∆SPI >10 or an absolute SPI value >50 as a predictor of inadequate analgesia. In other studies, only an absolute value of ∆SPI >50 was an indication for rescue analgesia [ 11 ]. In the methodology of the current study, a compromising protocol of ∆SPI >15, compared to the calculated baseline during Stage 2 and lasting at least one minute, was adopted as an indicator for rescue analgesia to avoid a potentially hazardous overdosage of FNT as a result of a potential miscalculation of the SPI score due to its variations.…”

“…The adequacy of anaesthesia (AoA), comprising the monitoring of RE, SE, NMT, and SPI, is crucial in assessing the quality of anaesthesia [ 7 ]. So far, we have published the current study findings regarding the influence of the employment of AoA guidance on GA with different PA techniques in patients undergoing VRS on the incidence of postoperative pain and perioperative haemodynamic stability [ 8 , 9 , 10 , 11 ] as preliminary reports. Currently, we investigate the intraoperative efficacy of various PA techniques, which are detected indirectly by observations of variations in SPI values, as an indication for IROA using FNT during various stages of VRS performed under AoA guidance.…”

Surgical pleth index monitoring in perioperative pain management: usefulness and limitations

“…Jung et al [40] evaluated whether the highest SPI during surgical incision was related to postoperative pain and opioid consumption. They recorded the highest SPI during surgical incision, and postoperative NRS scores for pain and opioid consumption during postoperative 24 h were compared between patients with SPI > 50 or 20-50.…”