Abdullayev Ruslan, Uludag Oznur, Celik Bulent
Marmara University Medical School, Anesthesiology and Reanimation Department, Istambul, Turquia.
Adiyaman University Medical School, Anesthesiology and Reanimation Department, Adiyaman, Turquia.
Braz J Anesthesiol. 2019 Jul-Aug;69(4):396-402. doi: 10.1016/j.bjan.2019.01.003. Epub 2019 Aug 6.
Patient self-rating based scales such as Numerical Rating Scale, Visual Analog Scale that is used for postoperative pain assessment may be problematic in geriatric or critically ill patients with communication problems. A method capable of the assessment of pain in objective manner has been searched for years. Analgesia nociception index, which is based on electrocardiographic data reflecting parasympathetic activity, has been proposed for this. In this study we aimed to investigate the effectiveness of analgesia nociception index as a tool for acute postoperative pain assessment. Our hypothesis was that analgesia nociception index may have good correlation with Numerical Rating Scale values.
A total of 120 patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing any surgical procedure under halogenated-based anesthesia with fentanyl or remifentanil were enrolled for the study. At the 15th minute of arrival to the Postoperative Care Unit the patients’ pain was rated on a 0–10 point Numerical Rating Scale. The patients’ heart rate, blood pressure, and analgesia nociception index scores were simultaneously measured at that time. The correlation between analgesia nociception index, heart rate, blood pressure and Numerical Rating Scale was examined.
The study was completed with 107 patients, of which 46 were males (43%). Mean (SD) analgesia nociception index values were significantly higher in patients with initial Numerical Rating Scale ≤3, compared with Numerical Rating Scale >3 (69.1 [13.4] vs. 58.1 [12.9] respectively, < 0.001). A significant negative linear relationship ( = −0.312, = 0.001) was observed between analgesia nociception index and Numerical Rating Scale.
Analgesia nociception index measurements at postoperative period after volatile agent and opioid-based anesthesia correlate well with subjective Numerical Rating Scale scores.
基于患者自评的量表，如用于术后疼痛评估的数字评定量表、视觉模拟量表，对于存在沟通问题的老年患者或危重症患者可能存在问题。多年来一直在寻找一种能够客观评估疼痛的方法。基于反映副交感神经活动的心电图数据的镇痛伤害感受指数已被提出用于此目的。在本研究中，我们旨在探讨镇痛伤害感受指数作为急性术后疼痛评估工具的有效性。我们的假设是镇痛伤害感受指数可能与数字评定量表值具有良好的相关性。
总共纳入120例美国麻醉医师协会（ASA）身体状况为I级和II级、在基于卤代麻醉剂并使用芬太尼或瑞芬太尼的麻醉下接受任何手术的患者进行研究。到达术后护理单元第15分钟时，使用0至10分的数字评定量表对患者的疼痛进行评分。同时测量此时患者的心率、血压和镇痛伤害感受指数得分。检查镇痛伤害感受指数、心率、血压与数字评定量表之间的相关性。
107例患者完成了研究，其中46例为男性（43%）。初始数字评定量表≤3分的患者的平均（标准差）镇痛伤害感受指数值显著高于数字评定量表>3分的患者（分别为69.1[13.4]和58.1[12.9]，<0.001）。镇痛伤害感受指数与数字评定量表之间观察到显著的负线性关系（= -0.312，= 0.001）。
挥发性麻醉剂和阿片类药物麻醉术后的镇痛伤害感受指数测量结果与主观数字评定量表得分具有良好的相关性。
