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Evaluation of Surgical Pleth Index and Analgesia Nociception Index as surrogate pain measures in conscious postoperative patients: an observational study

  • Joo-Hyun Lee
  • Byung-Moon Choi
  • Yu-Ri Jung
  • Yong-Hun Lee
  • Ji-Yeon BangEmail author
  • Gyu-Jeong Noh
Original Research
  • 79 Downloads

Abstract

We evaluated the performance of the Surgical Plethysmographic Index (SPI) and the Analgesia Nociception Index (ANI) as surrogate pain measures and determined their respective cut-off values for detecting pain in conscious postoperative patients. In total, 192 patients after elective surgery were enrolled. Baseline SPI and ANI data were acquired for 10 min in the operating room prior to surgery when the patients rated their pain as 0 on the numerical rating scale (NRS). Upon arrival in the post-anaesthesia care unit (PACU) after surgery, SPI and ANI data were recorded for 10 min. The means of the recorded data at OR and PACU were defined as the values representing baseline and postoperative pain, respectively. SPI and ANI data obtained from 189 patients were analysed, who were anesthetized with propofol (n = 149) or sevoflurane (n = 40). Remifentanil was continuously infused intraoperatively in all patients. The values of SPI and ANI were significantly different in conscious patients without (NRS = 0) and with pain (NRS > 0). The areas under the receiver operating curves for SPI and ANI were 0.73 (P < 0.0001) and 0.67 (P < 0.0001), respectively. The cut-off values for SPI and ANI in predicting postoperative pain were 44 (sensitivity: 84%, specificity: 53%) and 63 (sensitivity: 52%, specificity: 82%), respectively, which are different from those suggested by their respective manufacturers for use in intraoperative state under general anaesthesia. The cut-off values of SPI and ANI for detecting pain were similar regardless of the type of anesthesia.

Keywords

Conscious Pain Performance Surgical Pleth Index Analgesia Nociception Index 

Abbreviation

ANI

Analgesia Nociception Index

ECG

Electrocardiogram

HBI

Heartbeat interval

HRV

Heart rate variability

NRS

Numerical Rating Scale

OR

Operating room

PCA

Patient-controlled analgesia

PACU

Post-anaesthesia care unit

PPGA

Photo-plethysmographic amplitude

ROC

Receiver operating curve

SPI

Surgical Plethysmographic Index

TOF

Train-of-four

Notes

Acknowledgments

We thank Dr Joon Seo Lim from the Scientific Publications Team at Asan Medical Center for his editorial assistance in preparing this manuscript. This work was supported by the Ministry of Trade, Industry & Energy, Korea (Grant Number 10047988).

Compliance with ethical standards

Competing interests

None

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Anaesthesiology and Pain Medicine, International St. Mary’s HospitalCatholic Kwandong UniversityIncheonKorea
  2. 2.Department of Anaesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  3. 3.Department of Clinical Pharmacology and Therapeutics, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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