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Demi Rci Ç, Duran M, Nakır H, Doğukan M, Tepe M, Uludağ Ö. Correlation of Block Success with Perfusion Index Measurement in Cases of Pediatric Surgery Under Caudal Epidural Block Anesthesia. J Perianesth Nurs 2024; 39:666-671. [PMID: 38363268 DOI: 10.1016/j.jopan.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 02/17/2024]
Abstract
PURPOSE One of the regional anesthetic procedures, caudal epidural block, is important for lower extremities surgeries in the pediatric patient population. The perfusion index (PI) value, which reflects vasomotor tone, can be used to indicate block success. The aim was to compare the role of perfusion index, heart rate, and mean arterial pressure in detecting the success of caudal epidural block and to investigate whether perfusion index was an earlier indicator in determining the success of the block in pediatric surgery cases. DESIGN A randomized controlled trial. METHODS The study included 58 patients, American Society of Anesthesiologists'classification 1, between the ages 1 and 6 years. In the left lateral decubitus posture, caudal epidural block was performed using a 23 or 25-gauge caudal needle and a dosage of 0.25% bupivacaine (1 mL/kg). At the 0, 1, 5, 7, 10, 15, and 20th minutes, peripheral oxygen saturation, heart rate, mean arterial pressure, and PI values were obtained using a probe attached to the first toe of the left foot. A successful caudal epidural block indication was defined as an increase of at least 100% in the PI value over the baseline value and a 15% decrease in mean arterial pressure and heart rate FINDINGS: PI represents the ratio of the photoplethysmography signal to pulsatile over nonpulsatile light absorbance. An increase in the PI value indicates that the block is effective. In the 20-minute follow-up period after caudal epidural block, there was at least a 100% increase in PI value in all of the patients at the seventh minute. An expected 15% reduction in mean arterial pressure was observed in 14.5% of the patients and an expected 15% reduction in heart rate was observed in 45.6% of the patients. CONCLUSIONS The results obtained from our study show that the increase in PI values is associated with caudal epidural block success. The PI value is more rapid, sensitive and objective than those produced by other parameters. Benefits include an earlier change in anesthesia management due to block failure and faster initiation to surgery, which reduces exposure to anesthetic chemicals.
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Affiliation(s)
- Çiğdem Demi Rci
- Anesthesiology and Reanimation Department, Adiyaman University Training and Research Hospital, Adiyaman, Türkiye.
| | - Mehmet Duran
- Anesthesiology and Reanimation Department Adiyaman University Faculty of Medicine, Adiyaman, Türkiye.
| | - Hamza Nakır
- Anesthesiology and Reanimation Department, Adiyaman University Training and Research Hospital, Adiyaman, Türkiye.
| | - Mevlüt Doğukan
- Anesthesiology and Reanimation Department Adiyaman University Faculty of Medicine, Adiyaman, Türkiye.
| | - Mehmet Tepe
- Anesthesiology and Reanimation Department Adiyaman University Faculty of Medicine, Adiyaman, Türkiye.
| | - Öznur Uludağ
- Anesthesiology and Reanimation Department Adiyaman University Faculty of Medicine, Adiyaman, Türkiye.
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Bihani P, Pandey A, Jha M, Paliwal N, Jaju R, Solanki R. Comparing Perfusion Index and Visual Analogue Scores for Postoperative Pain Assessment Following Upper Limb Surgeries Under Supraclavicular Brachial Plexus Block: An Observational Study. Cureus 2024; 16:e55529. [PMID: 38576659 PMCID: PMC10993003 DOI: 10.7759/cureus.55529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Effective pain assessment is crucial to tailor the analgesic regimen post-operatively. Perfusion index (PI) has been reported to be a useful objective assessment tool for monitoring pain. This study aimed to explore the utility of PI in assessing postoperative pain in upper limb surgeries under supraclavicular block and its correlation with visual analogue scale (VAS) scores. METHODS This prospective, observational study included 140 patients scheduled for elective upper limb surgeries. PI, VAS scores, heart rate (HR), mean arterial pressure (MAP) and physiological parameters were recorded at baseline and postoperatively. Inj. tramadol was administered when the VAS score exceeded ≥ 4 and the VAS score, PI, HR and MAP were recorded at 5, 10, 15 and 20 minutes after administration. Comparison of normally and non-normally distributed data was done using t-statistics and Mann-Whitney U-test respectively. Pearson correlation was used to establish a correlation between variables and the receiver operating characteristic (ROC) curve was used to calculate the cut-off value of PI to determine the onset of pain. RESULTS There was a significant and moderate correlation between pre-analgesic and post-analgesic PI and VAS score (r = -0.425 and -0.448 respectively, p<0.001), while PI and MAP or PI and HR showed only a weak correlation. A cut-off value of 14.7 for PI showed 76.3% sensitivity and 100% specificity in predicting rescue analgesia requirements. CONCLUSION The study supports the use of PI as an objective measure for postoperative pain assessment, with a notable correlation with VAS scores. The identified cut-off value for PI adds to its clinical utility in predicting the need for rescue analgesia.
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Affiliation(s)
- Pooja Bihani
- Anesthesiology, Dr. Sampurnanand Medical College, Jodhpur, IND
| | - Akanksha Pandey
- Anesthesiology, Pacific Medical College and Hospital, Udaipur, IND
| | - Manish Jha
- Anesthesiology, Dr. Sampurnanand Medical College, Jodhpur, IND
| | - Naveen Paliwal
- Anesthesiology, Dr. Sampurnanand Medical College, Jodhpur, IND
| | - Rishabh Jaju
- Anesthesiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Ajayan N, Hrishi AP, Mathew O, Saravanan G. Evaluation and correlation of nociceptive response index and spectral entropy indices as monitors of nociception in anesthetized patients. J Neurosci Rural Pract 2023; 14:440-446. [PMID: 37692802 PMCID: PMC10483196 DOI: 10.25259/jnrp_75_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 09/12/2023] Open
Abstract
Objectives During anesthesia, the response to these stimuli depends on the balance between nociception and antinociception. Recently, various monitoring systems based on the variables derived from electroencephalography, plethysmography, autonomic tone, reflex pathways, and composite algorithms have been introduced for monitoring nociception. The main aim of our study was to evaluate and correlate the physiological variables which reflect the autonomic nervous system response to nociception, such as heart rate (HR), systolic blood pressure (SBP), perfusion index (PI), and nociceptive response index (NRI), with the spectral entropy indices response entropy (RE) and RE-state entropy (SE), which reflects electromyographic (EMG) activation as a response to pain. Materials and Methods This is a retrospective analysis of the data from a prospective study on the hypnotic and analgesic effects and the recovery profile of sevoflurane-based general anesthesia. Eighty-six patients undergoing single-agent sevoflurane anesthesia were recruited in the study. The study parameters, HR, SBP, SE, RE, RE-SE, PI, and NRI, were recorded at predefined time points before and after a standardized noxious stimulus. Correlation between the variables was carried out by applying the Pearson correlation equation for normal and the Spearman correlation equation for non-normally distributed data. Receiver operating characteristic (ROC) graphs were plotted, and the area under the curve was calculated to assess the diagnostic accuracy of post-stimulus NRI in detecting pain which was defined as RE-SE >10. Results There was a significant increase in the SBP, HR, NRI, RE, SE, and RE-SE and a considerable decrease in PI values during the post-noxious period compared to the pre-noxious period. There was no correlation between the absolute values of NRI and entropy indices at T2. However, among the reaction values, there was a weak correlation between the reaction values of NRI and RE (r = 0.30; P = 0.05). The area under the ROC curve for NRI to detect pain as defined by RE-SE >10 was 0.56. Conclusion During sevoflurane anesthesia, the application of noxious stimulus causes significant changes in variables reflecting sympathetic response and EMG activity. However, NRI failed to detect nociception, and there was only a weak correlation between the reaction values of NRI and RE-SE.
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Affiliation(s)
- Neeraja Ajayan
- Department of Neuroanesthesia and Critical Care, National Institute for Neurology and Neurosurgery, University College of London NHS Hospital Trust, London, United Kingdom
| | - Ajay Prasad Hrishi
- Department of Neuroanesthesia and Critical Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Oommen Mathew
- Department of Biostatics, University of Kerala, Thiruvananthapuram, Kerala, India
| | - Gourinandan Saravanan
- Department of Chemistry and Biochemistry, University of Maryland, Baltimore, United States
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Kim D, Lee C, Bae H, Kim J, Oh EJ, Jeong JS. Comparison of the perfusion index as an index of noxious stimulation in monitored anesthesia care of propofol/remifentanil and propofol/dexmedetomidine: a prospective, randomized, case-control, observational study. BMC Anesthesiol 2023; 23:183. [PMID: 37237353 DOI: 10.1186/s12871-023-02116-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Dexmedetomidine, one of the sedatives, has an analgesic effect. We aimed to investigate postoperative analgesia with dexmedetomidine as adjuvants for procedural sedation using perfusion index (PI). METHODS In this prospective, randomized, case-control, observational study, 72 adult patients, 19-70 years, who were scheduled for chemoport insertion under monitored anesthesia care were performed. According to the group assignment, remifentanil or dexmedetomidine was simultaneously infused with propofol. The primary outcome was PI 30 min after admission to the post anesthesia care unit (PACU). And, pain severity using numerical rating scale (NRS) score and the relationship between NRS score and PI were investigated. RESULTS During PACU staying, PI values were significantly different between the two groups PI values at 30 min after admission to the PACU were 1.3 (0.9-2.0) in the remifentanil group and 4.5 (2.9-6.8) in the dexmedetomidine group (median difference, 3; 95% CI, 2.1 to 4.2; P < 0.001). The NRS scores at 30 min after admission to the PACU were significantly lower in the dexmedetomidine group (P = 0.002). However, there was a weak positive correlation between NRS score and PI in the PACU (correlation coefficient, 0.188; P = 0.01). CONCLUSION We could not find a significant correlation between PI and NRS score for postoperative pain control. Using PI as a single indicator of pain is insufficient. TRIAL REGISTRATION Clinical Trial Registry of Korea, https://cris.nih.go.kr : KCT0003501, the date of registration: 13/02/2019.
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Affiliation(s)
- Doyeon Kim
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Changjin Lee
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - HanWool Bae
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Jung Oh
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University Scholl of Medicine, Gwangmyeong, Korea
| | - Ji Seon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, 06351, Gangnam, Seoul, Korea.
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Saglietto A, Scarsoglio S, Canova D, De Ferrari GM, Ridolfi L, Anselmino M. Beat-to-beat finger photoplethysmography in atrial fibrillation patients undergoing electrical cardioversion. Sci Rep 2023; 13:6751. [PMID: 37185372 PMCID: PMC10130175 DOI: 10.1038/s41598-023-33952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
Atrial fibrillation (AF)-induced peripheral microcirculatory alterations have poorly been investigated. The present study aims to expand current knowledge through a beat-to-beat analysis of non-invasive finger photoplethysmography (PPG) in AF patients restoring sinus rhythm by electrical cardioversion (ECV). Continuous non-invasive arterial blood pressure and left middle finger PPG pulse oximetry waveform (POW) signals were continuously recorded before and after elective ECV of consecutive AF or atrial flutter (AFL) patients. The main metrics (mean, standard deviation, coefficient of variation), as well as a beat-to-beat analysis of the pulse pressure (PP) and POW beat-averaged value (aPOW), were computed to compare pre- and post-ECV phases. 53 patients (mean age 69 ± 8 years, 79% males) were enrolled; cardioversion was successful in restoring SR in 51 (96%) and signal post-processing was feasible in 46 (87%) patients. In front of a non-significant difference in mean PP (pre-ECV: 51.96 ± 13.25, post-ECV: 49.58 ± 10.41 mmHg; p = 0.45), mean aPOW significantly increased after SR restoration (pre-ECV: 0.39 ± 0.09, post-ECV: 0.44 ± 0.06 a.u.; p < 0.001). Moreover, at beat-to-beat analysis linear regression yielded significantly different slope (m) for the PP (RR) relationship compared to aPOW(RR) [PP(RR): 0.43 ± 0.18; aPOW(RR): 1.06 ± 0.17; p < 0.001]. Long (> 95th percentile) and short (< 5th percentile) RR intervals were significantly more irregular in the pre-ECV phases for both PP and aPOW; however, aPOW signal suffered more fluctuations compared to PP (p < 0.001 in both phases). Present findings suggest that AF-related hemodynamic alterations are more manifest at the peripheral (aPOW) rather than at the upstream macrocirculatory level (PP). Restoring sinus rhythm increases mean peripheral microvascular perfusion and decreases variability of the microvascular hemodynamic signals. Future dedicated studies are required to determine if AF-induced peripheral microvascular alterations might relate to long-term prognostic effects.
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Affiliation(s)
- Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefania Scarsoglio
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129, Turin, Italy.
| | - Daniela Canova
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Ridolfi
- Department of Environmental, Land and Infrastructure Engineering, Politecnico di Torino, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Cardiovascular and Thoracic Department, ″Citta della Salute e della Scienza″ Hospital, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
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On the use of indexes derived from photoplethysmographic (PPG) signals for postoperative pain assessment: A narrative review. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gulen M, Satar S, Acehan S, Yildiz D, Aslanturkiyeli EF, Aka Satar D, Kucukceylan M. Perfusion index versus visual analogue scale: as an objective tool of renal colic pain in emergency department. Heliyon 2022; 8:e10606. [PMID: 36148281 PMCID: PMC9485029 DOI: 10.1016/j.heliyon.2022.e10606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/09/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background Perfusion index (PI) has use to monitor sympathetic response changes to pain. In this study, we aimed to evaluate the utility of using perfusion index as an objective marker of pain relief and of the need for rescue analgesia in ED patients with documented renal colic. Methods We conducted a prospective observational study between January 2020 and December 2020. The demographic characteristics of the patients, their complaints, nephrolithiasis histories, vital signs, PI, and VAS scores (on admission and after treatment) were recorded. Results A total of 144 patients were included. All patients were administered 20 mg of Tenoxicam on admission. There was a statistically significant difference between the PI (<0.001) and VAS scores (<0.001) on admission and after the administration of Tenoxicam. 43.1% (n = 62) of the patients needed rescue analgesia. Accordingly to ROC curve, the ability of both PI2 (AUC: 0.615, 95%CI 0.519-0.711, p = 0.018) and ΔPI (AUC: 0.601, 95%CI 0.508-0.694, p = 0.039) indices were determined as statistically significant. The cutoff value of the PI2 level for the prediction of the needed rescue analgesia was 4.65 and the cutoff value for ΔPI (PI2-PI1) was 2. All patients had a pain VAS score of <3 and a mean PI of 5.7 ± 2.9 at discharge from the emergency department. Conclusion In patients presenting to the emergency department with renal colic, the PI value on admission and after analgesic therapy can be helpful in assessing the severity of pain and predict the need for rescue analgesia.
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Affiliation(s)
- Muge Gulen
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
- Corresponding author.
| | - Salim Satar
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Selen Acehan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
| | - Derviş Yildiz
- Iskenderun State Hospital, Department of Emergency Medicine, Hatay, Turkey
| | | | - Deniz Aka Satar
- Adana City Training and Research Hospital, Department of Histology and Embryology and Andrology Laboratory, Adana, Turkey
| | - Melike Kucukceylan
- Adana City Training and Research Hospital, Department of Emergency Medicine, Adana, Turkey
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Park J, Seok HS, Kim SS, Shin H. Photoplethysmogram Analysis and Applications: An Integrative Review. Front Physiol 2022; 12:808451. [PMID: 35300400 PMCID: PMC8920970 DOI: 10.3389/fphys.2021.808451] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/21/2021] [Indexed: 12/03/2022] Open
Abstract
Beyond its use in a clinical environment, photoplethysmogram (PPG) is increasingly used for measuring the physiological state of an individual in daily life. This review aims to examine existing research on photoplethysmogram concerning its generation mechanisms, measurement principles, clinical applications, noise definition, pre-processing techniques, feature detection techniques, and post-processing techniques for photoplethysmogram processing, especially from an engineering point of view. We performed an extensive search with the PubMed, Google Scholar, Institute of Electrical and Electronics Engineers (IEEE), ScienceDirect, and Web of Science databases. Exclusion conditions did not include the year of publication, but articles not published in English were excluded. Based on 118 articles, we identified four main topics of enabling PPG: (A) PPG waveform, (B) PPG features and clinical applications including basic features based on the original PPG waveform, combined features of PPG, and derivative features of PPG, (C) PPG noise including motion artifact baseline wandering and hypoperfusion, and (D) PPG signal processing including PPG preprocessing, PPG peak detection, and signal quality index. The application field of photoplethysmogram has been extending from the clinical to the mobile environment. Although there is no standardized pre-processing pipeline for PPG signal processing, as PPG data are acquired and accumulated in various ways, the recently proposed machine learning-based method is expected to offer a promising solution.
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Affiliation(s)
- Junyung Park
- Department of Biomedical Engineering, Chonnam National University, Yeosu, South Korea
| | - Hyeon Seok Seok
- Department of Biomedical Engineering, Chonnam National University, Yeosu, South Korea
| | - Sang-Su Kim
- Department of Biomedical Engineering, Chonnam National University, Yeosu, South Korea
| | - Hangsik Shin
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Eadara V, Surekha C, Satish Kumar MN. Evaluation of perfusion index as an objective tool to assess analgesia during laparoscopic surgeries under general anaesthesia. Indian J Anaesth 2022; 66:260-265. [PMID: 35663221 PMCID: PMC9159402 DOI: 10.4103/ija.ija_658_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/03/2021] [Accepted: 03/29/2022] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Methods: Results: Conclusion:
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Validity of Pulse Oximetry-derived Peripheral Perfusion Index in Pain Assessment in Critically Ill Intubated Patients. Clin J Pain 2021; 37:904-907. [PMID: 34757342 DOI: 10.1097/ajp.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Evaluation of pain in critically ill intubated patients is difficult and subjective. This study aimed to evaluate the accuracy of oximetry-derived peripheral perfusion index (PPI) in pain assessment in critically ill intubated patients using the behavioral pain scale (BPS) as a reference. MATERIALS AND METHODS This prospective observational study included 35 adult mechanically ventilated surgical patients during their first 2 postoperative days in the intensive care unit. Values of PPI, BPS, Richmond Agitation Sedation Scale (RASS), heart rate, and blood pressure were obtained before and after a standard painful stimulus (changing the patient position) and the ratio between the second and the first reading was calculated to determine the change (Δ) in all variables. The outcomes were the correlation between ΔBPS and ΔPPI as well as other hemodynamic parameters. The ability of the PPI to detect pain (defined as BPS ≥6) was analyzed using the area under receiver operating characteristic curve. RESULTS Paired readings were obtained from 35 patients. After the standard painful stimulus, the PPI decreased while the BPS and the Richmond agitation sedation scale increased. The Spearman correlation coefficient (95% confidence interval) between Δ PPI and Δ BPS was 0.41 (0.09-0.65). PPI values showed poor accuracy in detecting pain with area under receiver operating characteristic curve (95% confidence interval): 0.65 (0.53-0.76), with best cutoff value of ≤2.7. CONCLUSION The PPI decreased after application of a standard painful stimulus in critically ill intubated patients. ∆PPI showed a low correlation with ∆BPS, and a PPI of ≤2.7 showed a low ability to detect BPS ≥6. Therefore, PPI should not be used for pain evaluation in critically ill intubated surgical patients.
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Shin H, Park J, Seok HS, Kim SS. Photoplethysmogram analysis and applications: An Integrative Review (Preprint). JMIR BIOMEDICAL ENGINEERING 2020. [DOI: 10.2196/25567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Evaluation of changes in perfusion index in patients with cytotoxic tissue damage after snake bite: A prospective cohort study. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.621050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Evaluation of the Intraoperative Perfusion Index for Correlation with Acute Postoperative Pain in Patients Undergoing Laparoscopic Colorectal Cancer Surgery. J Clin Med 2019; 8:jcm8091299. [PMID: 31450578 PMCID: PMC6780147 DOI: 10.3390/jcm8091299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/17/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022] Open
Abstract
Despite technical advancements in the perioperative management of cancer surgery, postoperative pain remains a significant clinical issue. We examined the diagnostic value of the intraoperative perfusion index for predicting acute postoperative pain in patients undergoing laparoscopic colorectal cancer surgery. We retrospectively analyzed data for 105 patients who had undergone laparoscopic colorectal cancer surgery. Patients with pain scores <7 and ≥7 on a 10-point scale upon arrival in the postoperative anesthesia care unit (PACU) were categorized into the N and P groups, respectively. The perfusion index value was extracted prior to intubation, at the start and end of surgery, and after extubation. To minimize individual variance in the absolute value of the perfusion index, we calculated the perfusion index change ratio. A total of 98 patients were examined. Among them, 50 (51.0%) and 48 (49.0%) patients reported pain scores of <7 and ≥7 upon arrival at the PACU, respectively. Fentanyl consumption during the intraoperative and PACU periods was significantly higher in Group P than in Group N (p < 0.001). The perfusion index change ratios did not significantly differ between the groups. The intraoperative perfusion index change ratios do not correlate with acute postoperative pain following laparoscopic colorectal cancer surgery.
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Correlation of Perfusion Index Change and Analgesic Efficacy in Transforaminal Block for Lumbosacral Radicular Pain. J Clin Med 2019; 8:jcm8010051. [PMID: 30621004 PMCID: PMC6352091 DOI: 10.3390/jcm8010051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/01/2019] [Accepted: 01/03/2019] [Indexed: 12/25/2022] Open
Abstract
Transforaminal epidural injection is used to treat radicular pain. However, there is no objective method of assessing pain relief following transforaminal injection. Perfusion index is a metric for monitoring peripheral perfusion status. This study evaluates the correlation between perfusion index change and analgesic efficacy in transforaminal blocks for lumbosacral radicular pain. We retrospectively analyzed data of 100 patients receiving transforaminal block for lumbosacral radicular pain. We assessed perfusion index before treatment and at 5, 15, and 30 min following the block. We defined responders (group R) and non-responders (group N) as those with ≥50% and <50% pain reduction, respectively, 30 min following block. Clinical data and perfusion index of the groups were analyzed. Ninety-two patients were examined, of whom 57 (61.9%) and 35 (38.0%) patients reported ≥50% and <50% pain reduction, respectively. Group R had a significantly higher perfusion index change ratio 5 min following the block (p = 0.029). A perfusion index change ratio of ≥0.27 was observed in group R (sensitivity, 75.4%; specificity, 51.4%; AUC (area under the curve), 0.636; p = 0.032). A perfusion index change ratio of ≥0.27 at 5 min after block is associated with, but does not predict improvement in, pain levels following lumbosacral transforaminal block.
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