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Evaluation of Surgical Pleth Index and Analgesia Nociception Index as surrogate pain measures in conscious postoperative patients: an observational study

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Abstract

We evaluated the performance of the Surgical Plethysmographic Index (SPI) and the Analgesia Nociception Index (ANI) as surrogate pain measures and determined their respective cut-off values for detecting pain in conscious postoperative patients. In total, 192 patients after elective surgery were enrolled. Baseline SPI and ANI data were acquired for 10 min in the operating room prior to surgery when the patients rated their pain as 0 on the numerical rating scale (NRS). Upon arrival in the post-anaesthesia care unit (PACU) after surgery, SPI and ANI data were recorded for 10 min. The means of the recorded data at OR and PACU were defined as the values representing baseline and postoperative pain, respectively. SPI and ANI data obtained from 189 patients were analysed, who were anesthetized with propofol (n = 149) or sevoflurane (n = 40). Remifentanil was continuously infused intraoperatively in all patients. The values of SPI and ANI were significantly different in conscious patients without (NRS = 0) and with pain (NRS > 0). The areas under the receiver operating curves for SPI and ANI were 0.73 (P < 0.0001) and 0.67 (P < 0.0001), respectively. The cut-off values for SPI and ANI in predicting postoperative pain were 44 (sensitivity: 84%, specificity: 53%) and 63 (sensitivity: 52%, specificity: 82%), respectively, which are different from those suggested by their respective manufacturers for use in intraoperative state under general anaesthesia. The cut-off values of SPI and ANI for detecting pain were similar regardless of the type of anesthesia.

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Abbreviations

ANI:

Analgesia Nociception Index

ECG:

Electrocardiogram

HBI:

Heartbeat interval

HRV:

Heart rate variability

NRS:

Numerical Rating Scale

OR:

Operating room

PCA:

Patient-controlled analgesia

PACU:

Post-anaesthesia care unit

PPGA:

Photo-plethysmographic amplitude

ROC:

Receiver operating curve

SPI:

Surgical Plethysmographic Index

TOF:

Train-of-four

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Acknowledgments

We thank Dr Joon Seo Lim from the Scientific Publications Team at Asan Medical Center for his editorial assistance in preparing this manuscript. This work was supported by the Ministry of Trade, Industry & Energy, Korea (Grant Number 10047988).

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Author notes

  1. Joo-Hyun Lee and Byung-Moon Choi equally contributed to this work as first authors.

Authors and Affiliations

  1. Department of Anaesthesiology and Pain Medicine, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea

    Joo-Hyun Lee

  2. Department of Anaesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea

    Byung-Moon Choi, Yu-Ri Jung, Yong-Hun Lee, Ji-Yeon Bang & Gyu-Jeong Noh

  3. Department of Clinical Pharmacology and Therapeutics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Gyu-Jeong Noh

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Lee, JH., Choi, BM., Jung, YR. et al. Evaluation of Surgical Pleth Index and Analgesia Nociception Index as surrogate pain measures in conscious postoperative patients: an observational study. J Clin Monit Comput 34, 1087–1093 (2020). https://doi.org/10.1007/s10877-019-00399-5

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