Liang Zenghui, Xie Yanle, Chen Shuhan, Liu Jing, Lv Huimin, Muhoza Bertrand-Geoffrey, Xing Fei, Mao Yuanyuan, Wei Xin, Xing Na, Yang Jianjun, Wang Zhongyu, Yuan Jingjing
Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Cognition and Emotion, Henan Province International Joint Laboratory of Pain, Zhengzhou, Henan, China.
Front Pediatr. 2024 Jul 18;12:1398182. doi: 10.3389/fped.2024.1398182. eCollection 2024.
While the pain threshold index (PTI) holds potential as a tool for monitoring analgesia-pain equilibrium, its precision in forecasting postoperative pain in children remains unconfirmed. This study's primary aim was to assess the PTI's predictive precision for postoperative pain.
Children (aged 2-16 years) undergoing general surgery under general anesthesia were included. Within 5 min prior to the patient's emergence from surgery, data including PTI, wavelet index (WLI), heart rates (HR) and mean arterial pressure (MAP) were collected. Subsequently, a 15-min pain assessment was conducted following the patient's awakening. The accuracy of these indicators in discerning between mild and moderate to severe postoperative pain was evaluated through receiver operating characteristic (ROC) analysis.
The analysis encompassed data from 90 children. ROC analysis showed that PTI was slightly better than HR, MAP and WLI in predicting postoperative pain, but its predictive value was limited. The area under the curve (AUC) was 0.659 [0.537∼0.780] and the optimal threshold was 65[64-67]. Sensitivity and specificity were determined at 0.90 and 0.50, respectively. In a multivariable logistic regression model, a higher predictive accuracy was found for a multivariable predictor combining PTI values with gender, BMI, HR and MAP (AUC, 0.768; 95%CI, 0.669-0.866). Upon further scrutinizing the age groups, PTI's AUC was 0.796 for children aged 9-16, 0.656 for those aged 4-8, and 0.601 for younger individuals.
PTI, when used alone, lacks acceptable accuracy in predicting postoperative pain in children aged 2 to 16 years. However, when combined with other factors, it shows improved predictive accuracy. Notably, PTI appears to be more accurate in older children.
虽然疼痛阈值指数（PTI）有望成为监测镇痛 - 疼痛平衡的工具，但其预测儿童术后疼痛的准确性仍未得到证实。本研究的主要目的是评估PTI对术后疼痛的预测准确性。
纳入接受全身麻醉下普通外科手术的2至16岁儿童。在患者手术结束前5分钟内，收集包括PTI、小波指数（WLI）、心率（HR）和平均动脉压（MAP）的数据。随后，在患者苏醒后进行15分钟的疼痛评估。通过受试者工作特征（ROC）分析评估这些指标在区分轻度与中度至重度术后疼痛方面的准确性。
分析涵盖了90名儿童的数据。ROC分析表明，PTI在预测术后疼痛方面略优于HR、MAP和WLI，但其预测价值有限。曲线下面积（AUC）为0.659[0.537∼0.780]，最佳阈值为65[64 - 67]。敏感性和特异性分别确定为0.90和0.50。在多变量逻辑回归模型中，将PTI值与性别、BMI、HR和MAP相结合的多变量预测指标具有更高的预测准确性（AUC，0.768；95%CI，0.669 - 0.866）。进一步按年龄组仔细分析，9至16岁儿童的PTI的AUC为0.796，4至8岁儿童为0.656，年龄较小者为0.601。
单独使用时，PTI在预测2至16岁儿童术后疼痛方面缺乏可接受的准确性。然而，与其他因素结合时，其预测准确性有所提高。值得注意的是，PTI在年龄较大的儿童中似乎更准确。
