Department of Anaesthesiology and Intensive Care, Édouard Herriot Hospital, HCL, Lyon, France.
Br J Anaesth. 2014 Apr;112(4):715-21. doi: 10.1093/bja/aet407. Epub 2013 Dec 8.
The analgesia/nociception index (ANI) is derived from heart rate variability, ranging from 0 (maximal nociception) to 100 (maximal analgesia), to reflect the analgesia/nociception balance during general anaesthesia. This should be correlated with immediate postoperative pain in the post-anaesthesia care unit (PACU). The aim of this study was to evaluate the performance of ANI measured at arousal from general anaesthesia to predict immediate postoperative pain on arrival in PACU.
Two hundred patients undergoing ear, nose, and throat or lower limb orthopaedic surgery with general anaesthesia using an inhalational agent and remifentanil were included in this prospective observational study. The ANI was measured immediately before tracheal extubation and pain intensity was assessed within 10 min of arrival in PACU using a 0-10 numerical rating scale (NRS). The relationship between ANI and NRS was assessed using linear regression. A receiver-operating characteristic (ROC) curve was used to evaluate the performance of ANI to predict NRS>3.
A negative linear relationship was observed between ANI immediately before extubation and NRS on arrival in PACU. Using a threshold of <50, the sensitivity and specificity of ANI to discriminate between patients with NRS≤3 and NRS>3 were both 86% with 92% negative predictive value, corresponding to an area under the ROC curve of 0.89.
The measurement of ANI immediately before extubation after inhalation-remifentanil anaesthesia was significantly associated with pain intensity on arrival in PACU. The performance of ANI for the prediction of immediate postoperative pain is good and may assist physicians in optimizing acute pain management.
ClinicalTrials.gov NCT01796249.
镇痛/伤害感受指数（ANI）源自心率变异性，范围从 0（最大伤害感受）到 100（最大镇痛），以反映全身麻醉期间的镇痛/伤害感受平衡。这应该与麻醉后护理单元（PACU）中的即刻术后疼痛相关。本研究的目的是评估从全身麻醉苏醒时测量的 ANI 预测 PACU 到达时即刻术后疼痛的性能。
本前瞻性观察研究纳入了 200 例接受吸入麻醉和瑞芬太尼全身麻醉的耳鼻喉或下肢矫形外科手术患者。在气管拔管前立即测量 ANI，并在 PACU 到达后 10 分钟内使用 0-10 数字评分量表（NRS）评估疼痛强度。使用线性回归评估 ANI 与 NRS 之间的关系。使用接收者操作特征（ROC）曲线评估 ANI 预测 NRS>3 的性能。
在气管拔管前，ANI 与 PACU 到达时的 NRS 呈负线性关系。使用阈值<50，ANI 区分 NRS≤3 和 NRS>3 患者的敏感性和特异性均为 86%，阴性预测值为 92%，ROC 曲线下面积为 0.89。
吸入-瑞芬太尼麻醉后拔管前测量的 ANI 与 PACU 到达时的疼痛强度显著相关。ANI 预测即刻术后疼痛的性能良好，可能有助于医生优化急性疼痛管理。
ClinicalTrials.gov NCT01796249。
