Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea.
J Clin Monit Comput. 2020 Jun;34(3):583-587. doi: 10.1007/s10877-019-00338-4. Epub 2019 Jun 17.
The aim of this study was to evaluate the performance of surgical pleth index (SPI) measured before arousal from general anaesthesia for prediction of immediate postoperative pain and postoperative opioid requirement during postoperative 48 h. After obtaining ethical approval and written informed consent, we enrolled 51 patients undergoing liver resection under isoflurane based general anaesthesia using laryngeal mask airway in this prospective observational study. Data relating to SPI values were recorded every 30 s for the last 3 min of surgery (bispectral index < 60 at all times). Postoperative pain intensity was assessed using a 0-10 numerical rating scale (NRS) every 10 min in the recovery room. The relationships between SPI with postoperative pain score and opioid requirement were analysed. A receiver-operating characteristic curve (ROC) was used to evaluate the performance of SPI to predict NRS ≥ 5. SPI value was significantly associated with the highest pain score in the recovery room (r = 0.63, p < 0.001). An SPI value of 60, which showed the highest sensitivity and specificity, was defined post hoc as the cut-off for moderate-severe pain (NRS ≥ 5). When compared the patients who showed SPI value over 60 or not, there was significant difference in the amount of fentanyl consumption during postoperative 48 h (1093 ± 406 µg vs. 766 ± 369 µg, p = 0.014; SPI ≥ 60 vs. SPI < 60). SPI measured before arousal after inhalation anaesthesia was associated with immediate postoperative pain and postoperative opioid consumption.
本研究旨在评估麻醉苏醒前的手术体动指数（SPI）对预测术后即刻疼痛和术后 48 小时内阿片类药物需求的作用。在获得伦理批准和书面知情同意后，我们对 51 例在异氟醚全身麻醉下使用喉罩进行肝切除术的患者进行了前瞻性观察研究。记录了手术最后 3 分钟内 SPI 值，每隔 30 秒记录一次（所有时间的脑电双频指数均<60）。在恢复室中，每 10 分钟使用 0-10 数字评分量表（NRS）评估术后疼痛强度。分析了 SPI 与术后疼痛评分和阿片类药物需求的关系。使用受试者工作特征曲线（ROC）评估 SPI 预测 NRS≥5 的性能。SPI 值与恢复室中最高疼痛评分显著相关（r=0.63，p<0.001）。术后将 SPI 值为 60 定义为中重度疼痛（NRS≥5）的截断值，该值显示出最高的灵敏度和特异性。当比较 SPI 值超过 60 或不超过 60 的患者时，术后 48 小时内芬太尼的消耗量存在显著差异（1093±406μg vs. 766±369μg，p=0.014；SPI≥60 vs. SPI<60）。吸入麻醉苏醒前测量的 SPI 与术后即刻疼痛和术后阿片类药物消耗有关。
