Surgical pleth index: prediction of postoperative pain and influence of arousal

Br J Anaesth. 2016 Sep;117(3):371-4. doi: 10.1093/bja/aew226.


Background: There are conflicting reports concerning the outcome after anaesthesia guided by the surgical pleth index (SPI; GE Healthcare, Helsinki, Finland). One potential explanation may be the lack of evidence for the selection of SPI cut-off values. The aim of this trial was to investigate the correlation between SPI, arousal, and postoperative pain and to define a cut-off value for SPI to predict moderate-to-severe pain.

Methods: After obtaining ethical approval and written informed consent, 70 patients undergoing non-emergency surgery were enrolled. Data relating to SPI, heart rate, mean arterial pressure, and state entropy were recorded every 10 s for the last 10 min of surgery (state entropy <60 at all times). Subsequently, recordings continued during the phase of arousal. After recovery room admission, pain scores (numerical rating scale 0-10) were obtained every 3 min for 15 min.

Results: Data from 65 patients were analysed. Receiver-operating characteristic curve analysis revealed an optimal intraoperative cut-off SPI value of 30 to discriminate between numerical rating scale scores 0-3 and 4-10. For this value, the negative and positive predictive values to discriminate between numerical rating scale scores 0-3 and 4-10 were 50 and 89.7%, respectively. The SPI was significantly affected by arousal, and SPI scores obtained during this phase were not predictive of postoperative pain.

Conclusions: Surgical pleth index values are predictive of postoperative pain only if obtained before patient arousal. In contrast to previous studies, a relatively low SPI, >30, appears to predict pain with a high positive predictive value and may therefore be suggested for future studies of SPI-guided anaesthesia.

Clinical trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12615000804583.

Keywords: anaesthesia; monitoring intraoperative; nociception; postoperative pain; pulse wave analysis.

MeSH terms

  • Adult
  • Arousal*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain, Postoperative / diagnosis*
  • Plethysmography*
  • Predictive Value of Tests