Format

Send to

Choose Destination
Br J Anaesth. 2016 Sep;117(3):371-4. doi: 10.1093/bja/aew226.

Surgical pleth index: prediction of postoperative pain and influence of arousal.

Author information

1
School of Medicine and Pharmacology, University of Western Australia, Level 2 Royal Perth Hospital MRF Building, Rear 50 Murray Street, Perth, WA 6000, Australia Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia.
2
Faculty of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany.
3
Department of Anaesthesia, Armadale Health Services, Perth, WA, Australia.

Abstract

BACKGROUND:

There are conflicting reports concerning the outcome after anaesthesia guided by the surgical pleth index (SPI; GE Healthcare, Helsinki, Finland). One potential explanation may be the lack of evidence for the selection of SPI cut-off values. The aim of this trial was to investigate the correlation between SPI, arousal, and postoperative pain and to define a cut-off value for SPI to predict moderate-to-severe pain.

METHODS:

After obtaining ethical approval and written informed consent, 70 patients undergoing non-emergency surgery were enrolled. Data relating to SPI, heart rate, mean arterial pressure, and state entropy were recorded every 10 s for the last 10 min of surgery (state entropy <60 at all times). Subsequently, recordings continued during the phase of arousal. After recovery room admission, pain scores (numerical rating scale 0-10) were obtained every 3 min for 15 min.

RESULTS:

Data from 65 patients were analysed. Receiver-operating characteristic curve analysis revealed an optimal intraoperative cut-off SPI value of 30 to discriminate between numerical rating scale scores 0-3 and 4-10. For this value, the negative and positive predictive values to discriminate between numerical rating scale scores 0-3 and 4-10 were 50 and 89.7%, respectively. The SPI was significantly affected by arousal, and SPI scores obtained during this phase were not predictive of postoperative pain.

CONCLUSIONS:

Surgical pleth index values are predictive of postoperative pain only if obtained before patient arousal. In contrast to previous studies, a relatively low SPI, >30, appears to predict pain with a high positive predictive value and may therefore be suggested for future studies of SPI-guided anaesthesia.

CLINICAL TRIAL REGISTRATION:

Australian New Zealand Clinical Trials Registry: ACTRN12615000804583.

KEYWORDS:

anaesthesia; monitoring intraoperative; nociception; postoperative pain; pulse wave analysis

PMID:
27543532
DOI:
10.1093/bja/aew226
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center