Tags

Type your tag names separated by a space and hit enter

Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain.
Br J Anaesth 2019; 123(2):e328-e332BJ

Abstract

BACKGROUND

Reported outcome benefits after surgical pleth index (SPI, GE Healthcare, Helsinki, Finland) guided anaesthesia are conflicting. One potential explanation may be the lack of evidence for the selection of meaningful SPI target values. A recently published trial found an SPI cut-off of 30 as a 'best-fit' to predict moderate-to-severe acute postoperative pain. This prospective trial was designed to validate this target and to investigate the influence of patient age on SPI in this context.

METHODS

After ethics approval, 200 patients undergoing non-emergency surgery were enrolled. Data related to SPI, heart rate (HR), and mean arterial pressure (MAP) were recorded for the last 5 min of surgery, just before arousal. After admission to recovery, pain scores (numeric rating scale [NRS], 0-10) were obtained every 5 min for 15 min.

RESULTS

The data of 196 patients were analysed. Receiver-operating curve analysis showed a cut-off SPI value of 29 to be the optimum intraoperative target to discriminate between NRS 0-3 and 4-10. This confirms the 'best fit' cut-off for SPI published previously. Though still superior to HR and MAP, the sensitivity and specificity of the SPI were only poor. Age had no influence on the predictive accuracy of SPI.

CONCLUSIONS

An SPI of approximately 30 was confirmed as having the best sensitivity/specificity to predict moderate-to-severe pain in the postanaesthesia care unit. However, the predictive accuracy was overall poor and not influenced by patient age.

CLINICAL TRIAL REGISTRATION

ACTRN12617001475336.

Authors+Show Affiliations

University of Western Australia, Perth, Australia; Royal Perth Hospital, Perth, Australia. Electronic address: Thomas.ledowski@health.wa.gov.au.Christian-Albrechts-University Kiel, Kiel, Germany.Christian-Albrechts-University Kiel, Kiel, Germany.Royal Perth Hospital, Perth, Australia.Royal Perth Hospital, Perth, Australia.Armadale Health Services, Perth, Australia.

Pub Type(s)

Journal Article
Observational Study
Validation Study

Language

eng

PubMed ID

30916030

Citation

Ledowski, T, et al. "Surgical Pleth Index: Prospective Validation of the Score to Predict Moderate-to-severe Postoperative Pain." British Journal of Anaesthesia, vol. 123, no. 2, 2019, pp. e328-e332.
Ledowski T, Schneider M, Gruenewald M, et al. Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain. Br J Anaesth. 2019;123(2):e328-e332.
Ledowski, T., Schneider, M., Gruenewald, M., Goyal, R. K., Teo, S. R., & Hruby, J. (2019). Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain. British Journal of Anaesthesia, 123(2), pp. e328-e332. doi:10.1016/j.bja.2018.10.066.
Ledowski T, et al. Surgical Pleth Index: Prospective Validation of the Score to Predict Moderate-to-severe Postoperative Pain. Br J Anaesth. 2019;123(2):e328-e332. PubMed PMID: 30916030.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain. AU - Ledowski,T, AU - Schneider,M, AU - Gruenewald,M, AU - Goyal,R K, AU - Teo,S R, AU - Hruby,J, Y1 - 2019/03/12/ PY - 2018/07/15/received PY - 2018/10/25/revised PY - 2018/10/31/accepted PY - 2019/3/28/pubmed PY - 2019/8/8/medline PY - 2019/3/28/entrez KW - age KW - monitor KW - pain assessment KW - postoperative pain KW - surgical pleth index SP - e328 EP - e332 JF - British journal of anaesthesia JO - Br J Anaesth VL - 123 IS - 2 N2 - BACKGROUND: Reported outcome benefits after surgical pleth index (SPI, GE Healthcare, Helsinki, Finland) guided anaesthesia are conflicting. One potential explanation may be the lack of evidence for the selection of meaningful SPI target values. A recently published trial found an SPI cut-off of 30 as a 'best-fit' to predict moderate-to-severe acute postoperative pain. This prospective trial was designed to validate this target and to investigate the influence of patient age on SPI in this context. METHODS: After ethics approval, 200 patients undergoing non-emergency surgery were enrolled. Data related to SPI, heart rate (HR), and mean arterial pressure (MAP) were recorded for the last 5 min of surgery, just before arousal. After admission to recovery, pain scores (numeric rating scale [NRS], 0-10) were obtained every 5 min for 15 min. RESULTS: The data of 196 patients were analysed. Receiver-operating curve analysis showed a cut-off SPI value of 29 to be the optimum intraoperative target to discriminate between NRS 0-3 and 4-10. This confirms the 'best fit' cut-off for SPI published previously. Though still superior to HR and MAP, the sensitivity and specificity of the SPI were only poor. Age had no influence on the predictive accuracy of SPI. CONCLUSIONS: An SPI of approximately 30 was confirmed as having the best sensitivity/specificity to predict moderate-to-severe pain in the postanaesthesia care unit. However, the predictive accuracy was overall poor and not influenced by patient age. CLINICAL TRIAL REGISTRATION: ACTRN12617001475336. SN - 1471-6771 UR - https://www.unboundmedicine.com/medline/citation/30916030/Surgical_pleth_index:_prospective_validation_of_the_score_to_predict_moderate_to_severe_postoperative_pain_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(19)30094-7 DB - PRIME DP - Unbound Medicine ER -