Key result
An elevated surgical pleth index at the end of surgery was associated with postoperative moderate-to-severe pain (mean difference 7.82; 95% CI 3.69 to 11.95; p=0.002).
Why the study?
Despite acceptance of the surgical pleth index for monitoring intraoperative nociception, its efficacy for predicting postoperative moderate-to-severe pain remained unclear.
Does an elevated Surgical Pleth Index at the end of surgery predict immediate postoperative moderate-to-severe pain in adults?
Meta-Analysis (n=756)
Does an elevated Surgical Pleth Index at the end of surgery predict immediate postoperative moderate-to-severe pain in adults?
Mean Difference: 7.82 (95% CI 3.69–11.95)
p-value: p=0.002
The surgical pleth index at the end of surgery is a feasible predictor of immediate postoperative moderate-to-severe pain.
SPI at surgery end shows unclear prediction of moderate-to-severe PACU pain; leaves open need for validated monitors in perioperative trials.
Despite acceptance of the surgical pleth index (SPI) for monitoring the intraoperative balance between noxious stimulation and anti-nociception under general anesthesia, its efficacy for predicting postoperative moderate-to-severe pain remains unclear. We searched electronic databases (e.g., Google Scholar, MEDLINE, Cochrane Library, and EMBASE) to identify articles focusing on associations of SPI at the end of surgery with immediate moderate-to-severe pain in the postanesthesia care unit from inception to 7 July 2022. A total of six observational studies involving 756 adults published between 2016 and 2020 were eligible for quantitative syntheses. Pooled results revealed higher values of SPI in patients with moderate-to-severe pain than those without (mean difference: 7.82, 95% CI: 3.69 to 11.95, p = 0.002, I2 = 46%). In addition, an elevated SPI at the end of surgery was able to predict moderate-to-severe pain with a sensitivity of 0.71 (95% confidence interval (CI): 0.65–0.77; I2 = 29.01%) and a specificity of 0.58 (95% CI: 0.39–0.74; I2 = 79.31%). The overall accuracy based on the summary receiver operating characteristic (sROC) curve was 0.72. In conclusion, this meta-analysis highlighted the feasibility of the surgical pleth index to predict postoperative moderate-to-severe pain immediately after surgery. Our results from a limited number of studies warrant further investigations for verification.
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Hung et al. (2022) conducted a meta-analysis in postoperative moderate-to-severe pain (n=756). Elevated surgical pleth index (SPI) at the end of surgery vs. Lower SPI was evaluated on SPI values in patients with vs without moderate-to-severe pain (MD 7.82, 95% CI 3.69 to 11.95, p=0.002). An elevated surgical pleth index at the end of surgery was associated with postoperative moderate-to-severe pain (mean difference 7.82; 95% CI 3.69 to 11.95; p=0.002).
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