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Updated: Aug 8, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Comparison of Surgical Pleth Index-guided Analgesia with Conventional Analgesia Practices in Children: A Randomized
Ji Hye Park1, Byung Gun Lim, Heezoo Kim
1From the Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Insights
Surgical pleth index (SPI)-guided analgesia in children undergoing adenotonsillectomy did not reduce intraoperative fentanyl needs but increased postoperative pain and agitation. SPI may not be valid for pediatric intraoperative pain assessment.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Pediatric anesthesia requires effective intraoperative analgesia and postoperative pain management.
- Emergence agitation is a common concern in children following surgery.
- The Surgical Pleth Index (SPI) is a tool used to monitor nociception and guide analgesia.
Purpose of the Study:
- To compare SPI-guided analgesia with conventional analgesia in pediatric adenotonsillectomy.
- To evaluate intraoperative analgesic requirements, postoperative pain, and emergence agitation.
Main Methods:
- A double-blind, randomized controlled trial involving 45 children.
- Patients were allocated to either SPI-guided or conventional analgesia groups.
- Anesthesia maintained with sevoflurane; fentanyl administered based on SPI thresholds or hemodynamic changes.
Main Results:
- Lower intraoperative fentanyl use in the SPI-guided group (P < 0.001).
- Higher incidence of emergence agitation (61.9% vs. 25.0%, P = 0.01) in the SPI-guided group.
- Increased postoperative pain scores and rescue fentanyl requirements in the SPI-guided group (P = 0.002; P = 0.04).
Conclusions:
- SPI, as currently designed, may not be valid for guiding analgesia in pediatric patients.
- Differences in pediatric physiology, such as blood vessel distensibility and heart rate, might affect SPI accuracy.
- Further research is needed to validate or adapt pain monitoring tools for pediatric populations.
Background:
To compare surgical pleth index (SPI)-guided analgesia with conventional analgesia by evaluating intraoperative analgesic requirements, postoperative pain, and emergence agitation in children.
Methods:
This study was designed as a parallel, two-arm, double-blind, randomized controlled trial. Forty-five children undergoing elective adenotonsillectomy were randomly allocated to SPI-guided group (SPI-guided analgesia group, n = 21) or control group (conventional analgesia group, n = 24). Anesthesia was maintained with sevoflurane 2 to 3 vol% in 50% nitrous oxide and oxygen to achieve state entropy between 40 and 60. Intraoperative fentanyl 0.5 μg/kg was administered for the first event persisting 3 min and subsequent events persisting 5 min. An event was defined as an SPI over 50 (SPI-guided group) or a blood pressure or heart rate 20% above the baseline (control group). The primary outcome was intraoperative fentanyl requirement. Secondary outcomes included intraoperative sevoflurane consumption, postoperative emergence agitation and pain score, and postoperative rescue analgesic requirements.
Results:
Intraoperative fentanyl requirement was lower in SPI-guided group than in control group (0.43 ± 0.53 vs. 1.73 ± 0.59 μg/kg; P < 0.001). Intraoperative sevoflurane consumption was similar. The proportion of patients with high emergence agitation scores (4 to 5) was greater in SPI-guided group (61.9 vs. 25.0%; P = 0.01). The postoperative pain score and rescue fentanyl consumption were higher in SPI-guided group (7 [4.5; 9] vs. 3 [2; 6.75]; P = 0.002; 0.50 ± 0.34 vs. 0.29 ± 0.30 μg/kg; P = 0.04).
Conclusions:
As currently constructed, SPI does not appear to be valid in children. This may be due to both differences in blood vessel distensibility and baseline increased heart rates in children versus adults.
