Department of Anaesthesia, Tampere University Hospital, PL2000, Tampere 33521, Finland
Department of Anaesthesia, Tampere University Hospital, PL2000, Tampere 33521, Finland.
Br J Anaesth. 2016 Sep;117(3):358-64. doi: 10.1093/bja/aew215.
The surgical pleth index (SPI) is a measurement of intraoperative nociception. Evidence of its usability in children is limited. Given that the autonomic nervous system is still developing during the first years of life, the performance of the SPI on small children cannot be concluded from studies carried out in older age groups.
Thirty children aged <2 yr, planned for elective open inguinal hernia repair or open correction of undescended testicle, were recruited. The children were randomized into two groups; the saline group received ultrasound-guided saline injection in the ilioinguinal and iliohypogastric nerve region before surgery and ropivacaine after surgery, whereas the block group received the injections in the opposite order. The SPI was recorded blinded and was analysed at the time points of intubation, incision, and when signs of inadequate anti-nociception were observed.
There was a significant increase in the SPI after intubation (P=0.019) and after incision in the saline group (P=0.048), but not at the time of surgical incision in the block group (P=0.177). An increase in the SPI was also seen at times of clinically apparent inadequate anti-nociception (P=0.008). The between-patient variability of the SPI was large.
The SPI is reactive in small children after intubation and after surgical stimuli, but the reactivity of the SPI is rather small, and there is marked inter-individual variability in reactions. The reactivity is blunted by the use of ilioinguinal and iliohypogastric nerve block.
NCT02045810.
手术痛觉指数（SPI）是一种术中痛觉的测量方法。其在儿童中的可用性证据有限。由于自主神经系统在生命的头几年仍在发育，因此不能根据在年龄较大的人群中进行的研究来推断 SPI 在幼儿中的表现。
招募了 30 名年龄<2 岁的儿童，计划进行择期开放腹股沟疝修补术或开放未降睾丸矫正术。这些儿童被随机分为两组；盐水组在手术前和手术后在髂腹股沟和髂腹下神经区域接受超声引导下的盐水注射，而阻滞组则按相反的顺序接受注射。SPI 进行盲法记录，并在插管、切口和观察到镇痛不足迹象时进行分析。
盐水组在插管后（P=0.019）和切口后（P=0.048）SPI 显著增加，但阻滞组在手术切口时（P=0.177）SPI 没有增加。在临床上明显镇痛不足的情况下，SPI 也有所增加（P=0.008）。SPI 患者间的变异性较大。
SPI 在小儿插管后和手术刺激后有反应，但 SPI 的反应性相当小，个体间反应的变异性很大。髂腹股沟和髂腹下神经阻滞会减弱 SPI 的反应性。
NCT02045810。
