Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study
Prediction of immediate postoperative pain using the analgesia/nociception index: a prospective observational study
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DOI：
10.1093/bja/aet407
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发表时间：
2014-04-01
影响因子：
9.8
通讯作者：
Allaouchiche, B.
中科院分区：
文献类型：
--
作者：
Boselli, E.;Bouvet, L.;Allaouchiche, B.
镇痛/伤害感受指数（ANI）由心率变异性得出，范围从0（最大伤害感受）到100（最大镇痛），以反映全身麻醉期间的镇痛/伤害感受平衡。这应该与麻醉后护理室 (PACU) 的术后即刻疼痛相关。本研究的目的是评估全身麻醉唤醒时测量的 ANI 的性能，以预测到达 PACU 时的术后即刻疼痛。 这项前瞻性观察性研究纳入了 200 名接受耳鼻喉或下肢骨科手术的患者，他们使用吸入剂和瑞芬太尼进行全身麻醉。在气管拔管前立即测量 ANI，并在到达 PACU 后 10 分钟内使用 010 数字评定量表 (NRS) 评估疼痛强度。使用线性回归评估 ANI 和 NRS 之间的关系。使用接受者操作特征 (ROC) 曲线来评估 ANI 预测 NRS3 的性能。在拔管前的 ANI 与到达 PACU 时的 NRS 之间观察到负线性关系。使用阈值 50，ANI 区分 NRS3 和 NRS3 患者的敏感性和特异性均为 86，阴性预测值为 92，对应 ROC 曲线下面积为 0.89。吸入瑞芬太尼麻醉后拔管前的 ANI 测量与到达 PACU 时的疼痛强度显着相关。 ANI 在预测术后即刻疼痛方面的表现良好，可以帮助医生优化急性疼痛管理。ClinicalTrials.gov NCT01796249。
The analgesia/nociception index (ANI) is derived from heart rate variability, ranging from 0 (maximal nociception) to 100 (maximal analgesia), to reflect the analgesia/nociception balance during general anaesthesia. This should be correlated with immediate postoperative pain in the post-anaesthesia care unit (PACU). The aim of this study was to evaluate the performance of ANI measured at arousal from general anaesthesia to predict immediate postoperative pain on arrival in PACU.Two hundred patients undergoing ear, nose, and throat or lower limb orthopaedic surgery with general anaesthesia using an inhalational agent and remifentanil were included in this prospective observational study. The ANI was measured immediately before tracheal extubation and pain intensity was assessed within 10 min of arrival in PACU using a 010 numerical rating scale (NRS). The relationship between ANI and NRS was assessed using linear regression. A receiver-operating characteristic (ROC) curve was used to evaluate the performance of ANI to predict NRS3.A negative linear relationship was observed between ANI immediately before extubation and NRS on arrival in PACU. Using a threshold of 50, the sensitivity and specificity of ANI to discriminate between patients with NRS3 and NRS3 were both 86 with 92 negative predictive value, corresponding to an area under the ROC curve of 0.89.The measurement of ANI immediately before extubation after inhalation-remifentanil anaesthesia was significantly associated with pain intensity on arrival in PACU. The performance of ANI for the prediction of immediate postoperative pain is good and may assist physicians in optimizing acute pain management.ClinicalTrials.gov NCT01796249.