Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain

T. Ledowski, M. Schneider, M. Gruenewald, R. K. Goyal, S. R. Teo, J. Hruby

Research output: Contribution to journalArticle

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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.

Original languageEnglish
Number of pages5
JournalBritish Journal of Anaesthesia
DOIs
Publication statusE-pub ahead of print - 12 Mar 2019

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Postoperative Pain
Arterial Pressure
Heart Rate
Sensitivity and Specificity
Pain
Acute Pain
Finland
Arousal
Ethics
Anesthesia
Clinical Trials
Delivery of Health Care

Cite this

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title = "Surgical pleth index: prospective validation of the score to predict moderate-to-severe postoperative pain",
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.",
keywords = "age, postoperative pain, surgical pleth index",
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Surgical pleth index : prospective validation of the score to predict moderate-to-severe postoperative pain. / Ledowski, T.; Schneider, M.; Gruenewald, M.; Goyal, R. K.; Teo, S. R.; Hruby, J.

In: British Journal of Anaesthesia, 12.03.2019.

Research output: Contribution to journalArticle

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AU - Ledowski, T.

AU - Schneider, M.

AU - Gruenewald, M.

AU - Goyal, R. K.

AU - Teo, S. R.

AU - Hruby, J.

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