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Surgical pleth index: prediction of postoperative pain in children?
Br J Anaesth 2017; 119(5):979-983BJ

Abstract

Background

Surgical Pleth Index (SPI) is a non-invasive, dimensionless score (0-100) aimed to allow an estimate of intraoperative nociception. Thus, it may be a useful tool to guide intraoperative analgesia. However, no optimum SPI target range for the use in children has yet been defined. It was the aim of this study to define a clinically appropriate SPI target to predict moderate-severe postoperative pain in children.

Methods

After ethics approval 105 children (2-16 yr) undergoing elective sevoflurane/opioid-based anaesthesia were included. SPI was recorded directly before the end of surgery and compared with acute postoperative pain (age appropriately assessed on different pain scales in the age groups two to three yr, four to eight yr and nine to16 yr) in the postoperative acute care unit (PACU).

Results

Data of 93 children were analysed. A significant negative correlation was found between age and SPI (r=-0.43; P=0.03). The SPI cut-off value with the highest sensitivity (76%) and specificity (62%) in all children combined was 40. The negative predictive value for SPI ≤ 40 to predict the absence of moderate-severe pain in PACU was 87.5%. The commonly used SPI cut-off (50) published in all related studies had neither any clinically relevant sensitivity nor specificity to predict the presence or absence of acute pain in PACU.

Conclusions

The results suggest that a lower (≤ 40) than previously published (50) target for SPI may be more appropriate in studies investigating SPI guided anaesthesia in children, if the avoidance of moderate-severe postoperative pain is the main goal.

Clinical trial registration

ACTRN12616001139460.

Authors+Show Affiliations

Medical School, University of Western Australia, Perth, Australia. Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Australia.Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia.Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia. Telethon Kids Institute, Perth, Australia.Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia. Medical School, Christian-Albrechts-University Kiel, Kiel, Germany.Medical School, University of Western Australia, Perth, Australia. Department of Anaesthesia, Princess Margaret Hospital for Children, Perth, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29028932

Citation

Ledowski, T, et al. "Surgical Pleth Index: Prediction of Postoperative Pain in Children?" British Journal of Anaesthesia, vol. 119, no. 5, 2017, pp. 979-983.
Ledowski T, Sommerfield D, Slevin L, et al. Surgical pleth index: prediction of postoperative pain in children? Br J Anaesth. 2017;119(5):979-983.
Ledowski, T., Sommerfield, D., Slevin, L., Conrad, J., & von Ungern-Sternberg, B. S. (2017). Surgical pleth index: prediction of postoperative pain in children? British Journal of Anaesthesia, 119(5), pp. 979-983. doi:10.1093/bja/aex300.
Ledowski T, et al. Surgical Pleth Index: Prediction of Postoperative Pain in Children. Br J Anaesth. 2017 Nov 1;119(5):979-983. PubMed PMID: 29028932.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical pleth index: prediction of postoperative pain in children? AU - Ledowski,T, AU - Sommerfield,D, AU - Slevin,L, AU - Conrad,J, AU - von Ungern-Sternberg,B S, PY - 2017/08/10/accepted PY - 2017/10/14/pubmed PY - 2019/4/18/medline PY - 2017/10/14/entrez KW - children KW - postoperative pain KW - surgical pleth index SP - 979 EP - 983 JF - British journal of anaesthesia JO - Br J Anaesth VL - 119 IS - 5 N2 - Background: Surgical Pleth Index (SPI) is a non-invasive, dimensionless score (0-100) aimed to allow an estimate of intraoperative nociception. Thus, it may be a useful tool to guide intraoperative analgesia. However, no optimum SPI target range for the use in children has yet been defined. It was the aim of this study to define a clinically appropriate SPI target to predict moderate-severe postoperative pain in children. Methods: After ethics approval 105 children (2-16 yr) undergoing elective sevoflurane/opioid-based anaesthesia were included. SPI was recorded directly before the end of surgery and compared with acute postoperative pain (age appropriately assessed on different pain scales in the age groups two to three yr, four to eight yr and nine to16 yr) in the postoperative acute care unit (PACU). Results: Data of 93 children were analysed. A significant negative correlation was found between age and SPI (r=-0.43; P=0.03). The SPI cut-off value with the highest sensitivity (76%) and specificity (62%) in all children combined was 40. The negative predictive value for SPI ≤ 40 to predict the absence of moderate-severe pain in PACU was 87.5%. The commonly used SPI cut-off (50) published in all related studies had neither any clinically relevant sensitivity nor specificity to predict the presence or absence of acute pain in PACU. Conclusions: The results suggest that a lower (≤ 40) than previously published (50) target for SPI may be more appropriate in studies investigating SPI guided anaesthesia in children, if the avoidance of moderate-severe postoperative pain is the main goal. Clinical trial registration: ACTRN12616001139460. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/29028932/Surgical_pleth_index:_prediction_of_postoperative_pain_in_children L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)53912-4 DB - PRIME DP - Unbound Medicine ER -