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Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study.
Br J Anaesth 2014; 112(4):715-21BJ

Abstract

BACKGROUND

The analgesia/nociception index (ANI) is derived from heart rate variability, ranging from 0 (maximal nociception) to 100 (maximal analgesia), to reflect the analgesia/nociception balance during general anaesthesia. This should be correlated with immediate postoperative pain in the post-anaesthesia care unit (PACU). The aim of this study was to evaluate the performance of ANI measured at arousal from general anaesthesia to predict immediate postoperative pain on arrival in PACU.

METHODS

Two hundred patients undergoing ear, nose, and throat or lower limb orthopaedic surgery with general anaesthesia using an inhalational agent and remifentanil were included in this prospective observational study. The ANI was measured immediately before tracheal extubation and pain intensity was assessed within 10 min of arrival in PACU using a 0-10 numerical rating scale (NRS). The relationship between ANI and NRS was assessed using linear regression. A receiver-operating characteristic (ROC) curve was used to evaluate the performance of ANI to predict NRS>3.

RESULTS

A negative linear relationship was observed between ANI immediately before extubation and NRS on arrival in PACU. Using a threshold of <50, the sensitivity and specificity of ANI to discriminate between patients with NRS≤3 and NRS>3 were both 86% with 92% negative predictive value, corresponding to an area under the ROC curve of 0.89.

CONCLUSIONS

The measurement of ANI immediately before extubation after inhalation-remifentanil anaesthesia was significantly associated with pain intensity on arrival in PACU. The performance of ANI for the prediction of immediate postoperative pain is good and may assist physicians in optimizing acute pain management.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov NCT01796249.

Authors+Show Affiliations

Department of Anaesthesiology and Intensive Care, Édouard Herriot Hospital, HCL, Lyon, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24322571

Citation

Boselli, E, et al. "Prediction of Immediate Postoperative Pain Using the Analgesia/nociception Index: a Prospective Observational Study." British Journal of Anaesthesia, vol. 112, no. 4, 2014, pp. 715-21.
Boselli E, Bouvet L, Bégou G, et al. Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study. Br J Anaesth. 2014;112(4):715-21.
Boselli, E., Bouvet, L., Bégou, G., Dabouz, R., Davidson, J., Deloste, J. Y., ... Allaouchiche, B. (2014). Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study. British Journal of Anaesthesia, 112(4), pp. 715-21. doi:10.1093/bja/aet407.
Boselli E, et al. Prediction of Immediate Postoperative Pain Using the Analgesia/nociception Index: a Prospective Observational Study. Br J Anaesth. 2014;112(4):715-21. PubMed PMID: 24322571.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study. AU - Boselli,E, AU - Bouvet,L, AU - Bégou,G, AU - Dabouz,R, AU - Davidson,J, AU - Deloste,J-Y, AU - Rahali,N, AU - Zadam,A, AU - Allaouchiche,B, Y1 - 2013/12/08/ PY - 2013/12/11/entrez PY - 2013/12/11/pubmed PY - 2014/5/9/medline KW - anaesthesia, general KW - analgesia KW - nociception KW - pain measurement SP - 715 EP - 21 JF - British journal of anaesthesia JO - Br J Anaesth VL - 112 IS - 4 N2 - BACKGROUND: The analgesia/nociception index (ANI) is derived from heart rate variability, ranging from 0 (maximal nociception) to 100 (maximal analgesia), to reflect the analgesia/nociception balance during general anaesthesia. This should be correlated with immediate postoperative pain in the post-anaesthesia care unit (PACU). The aim of this study was to evaluate the performance of ANI measured at arousal from general anaesthesia to predict immediate postoperative pain on arrival in PACU. METHODS: Two hundred patients undergoing ear, nose, and throat or lower limb orthopaedic surgery with general anaesthesia using an inhalational agent and remifentanil were included in this prospective observational study. The ANI was measured immediately before tracheal extubation and pain intensity was assessed within 10 min of arrival in PACU using a 0-10 numerical rating scale (NRS). The relationship between ANI and NRS was assessed using linear regression. A receiver-operating characteristic (ROC) curve was used to evaluate the performance of ANI to predict NRS>3. RESULTS: A negative linear relationship was observed between ANI immediately before extubation and NRS on arrival in PACU. Using a threshold of <50, the sensitivity and specificity of ANI to discriminate between patients with NRS≤3 and NRS>3 were both 86% with 92% negative predictive value, corresponding to an area under the ROC curve of 0.89. CONCLUSIONS: The measurement of ANI immediately before extubation after inhalation-remifentanil anaesthesia was significantly associated with pain intensity on arrival in PACU. The performance of ANI for the prediction of immediate postoperative pain is good and may assist physicians in optimizing acute pain management. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01796249. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/24322571/Prediction_of_immediate_postoperative_pain_using_the_analgesia/nociception_index:_a_prospective_observational_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)30889-9 DB - PRIME DP - Unbound Medicine ER -