T Ledowski1, M Schneider2, M Gruenewald2, R K Goyal3, S R Teo3, J Hruby4. 1. University of Western Australia, Perth, Australia; Royal Perth Hospital, Perth, Australia. Electronic address: Thomas.ledowski@health.wa.gov.au. 2. Christian-Albrechts-University Kiel, Kiel, Germany. 3. Royal Perth Hospital, Perth, Australia. 4. Armadale Health Services, Perth, Australia.
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.
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: Federico Coccolini; Francesco Corradi; Massimo Sartelli; Raul Coimbra; Igor A Kryvoruchko; Ari Leppaniemi; Krstina Doklestic; Elena Bignami; Giandomenico Biancofiore; Miklosh Bala; Ceresoli Marco; Dimitris Damaskos; Walt L Biffl; Paola Fugazzola; Domenico Santonastaso; Vanni Agnoletti; Catia Sbarbaro; Mirco Nacoti; Timothy C Hardcastle; Diego Mariani; Belinda De Simone; Matti Tolonen; Chad Ball; Mauro Podda; Isidoro Di Carlo; Salomone Di Saverio; Pradeep Navsaria; Luigi Bonavina; Fikri Abu-Zidan; Kjetil Soreide; Gustavo P Fraga; Vanessa Henriques Carvalho; Sergio Faria Batista; Andreas Hecker; Alessandro Cucchetti; Giorgio Ercolani; Dario Tartaglia; Joseph M Galante; Imtiaz Wani; Hayato Kurihara; Edward Tan; Andrey Litvin; Rita Maria Melotti; Gabriele Sganga; Tamara Zoro; Alessandro Isirdi; Nicola De'Angelis; Dieter G Weber; Adrien M Hodonou; Richard tenBroek; Dario Parini; Jim Khan; Giovanni Sbrana; Carlo Coniglio; Antonino Giarratano; Angelo Gratarola; Claudia Zaghi; Oreste Romeo; Michael Kelly; Francesco Forfori; Massimo Chiarugi; Ernest E Moore; Fausto Catena; Manu L N G Malbrain Journal: World J Emerg Surg Date: 2022-09-21 Impact factor: 8.165