Comparison of relative oxycodone consumption in surgical pleth index-guided analgesia versus conventional analgesia during sevoflurane anesthesia

Abstract

Background:The surgical pleth index (SPI) is proposed for titration of analgesic drugs during general anesthesia. Several reports have investigated the effect of SPI on the consumption of opioids including remifentanil, fentanyl, and sufentanil during anesthesia, but there are no reports about oxycodone. We aimed to investigate intravenous oxycodone consumption between SPI-guided analgesia and conventional analgesia practices during sevoflurane anesthesia in patients undergoing thyroidectomy.Methods:Forty-five patients undergoing elective thyroidectomy were randomly assigned to an SPI group (SPI-guided analgesia group, n = 23) or a control group (conventional analgesia group, n = 22). Anesthesia was maintained with sevoflurane to achieve bispectral index values between 40 and 60. In the SPI group, oxycodone 1 mg was administered intravenously at SPI values over 50; in the control group, oxycodone 1 mg was administered intravenously at the occurrence of tachycardia or hypertension event. Intraoperative oxycodone consumption and extubation time were recorded. The number of hemodynamic and somatic movement events was recorded, as were postoperative pain and recovery scores.Results:Patients’ characteristics were comparable between the groups. Intraoperative oxycodone consumption in the SPI group was significantly lower than the control group (3.5 ± 2.4 vs 5.1 ± 2.4 mg; P = 0.012). Extubation time was significantly shorter in the SPI group (10.6 ± 3.5 vs 13.4 ± 4.6 min; P = 0.026). Hemodynamic and somatic movement events during anesthesia were comparable between the groups, as were numeric rating scales for pain and modified Aldrete scores at postanesthesia care unit.Conclusions:SPI-guided analgesia reduces intravenous oxycodone consumption and extubation time compared with conventional analgesia based on clinical parameters during sevoflurane anesthesia in patients undergoing thyroidectomy.

Does nociception monitor-guided anesthesia affect opioid consumption? A systematic review of randomized controlled trials

“…A total of 1045 patients were studied, with 520 receiving an intervention compared to 526 treated according to routine clinical care. Care guided using the SPI was evaluated in six studies [16][17][18][19][20][21] followed by the ANI in three studies [22][23][24]. The NOL, pupillometry and the beat-to-beat cardiovascular depth of anesthesia index (CARDEAN 2.0) were evaluated in single studies [15,25,26].…”

“…Six reports were identified that compared SPI guided anesthesia to standard practice [16][17][18][19][20][21]. Studies were diverse with regard to the maintenance hypnotic (propofol or sevoflurane) and opioids (remifentanil/sufentanil/ fentanyl and oxycodone).…”

Prediction of hemodynamic reactivity by electroencephalographically derived Pain Rating Index in children during general anesthesia: a prospective observational study

“…Therefore, several monitoring tools including ANI, Surgical Pleth Index (SPI), and Nociception level (NoL) have been developed to evaluate nociception during general anesthesia through the analysis of the relative parasympathetic tone. Researches have shown that these tools might reflect the nociception during general anesthesia [1,16,21]. However, these parameters are mainly aimed at adult patients and affected by arrhythmia alongside many heart rate affecting drugs [6,25].…”

“…For pediatric patients younger than 4 years old, 0.5mg/kg midazolam PO 20-30 mins before entering the operating room, other patients did not receive any premedication. On arrival in the operation room, intravenous access and basic monitoring with an electrocardiogram, and pulse oximetry were established, and a crystalloid infusion was started following 4-2-1 principals [16]. Noninvasive blood pressure in the arm was recorded every 1 min during the experiment.…”

“…Furthermore, many confounding factors such as hypovolemia, β-blockers, anticholinergic drugs can also interfere with these clinical signs [12]. In recent years, several noninvasive monitoring tools based on skin conductance (SC), pupil diameter, heart rate variability (HRV), amplitude from photoplethymography (Surgical Pleth Index) or analysis of electroencephalogram (EEG) signals to estimate the antinociceptive state during general anesthesia has been used in adults, but less common in children, which might be due to age-dependent characteristics of EEG, ECG or lack of pediatric electrodes [11,[13][14][15][16][17].…”