Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study
Autor(a) principal: | |
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Data de Publicação: | 2020 |
Outros Autores: | , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.2/11446 |
Resumo: | Pupillary reflex dilation (PRD) is triggered by noxious stimuli and diminished by opioid administration. In the postoperative period, PRD has been shown to be correlated with pain reporting and a useful tool to guide opioid administration. In this study we assessed whether pupillary measurements taken before extubation were related with the patient's reported pain in the Post-Anesthesia Care Unit (PACU) using the Numerical Rating Scale (NRS). Our objective was to evaluate the correlation of PRD and pupillary variables measured intraoperatively with postoperative pain under the same opioid concentration. This was a prospective observational study of 26 neurosurgical patients undergoing general anesthesia exclusively with propofol and remifentanil. A portable infrared pupillometer was used to provide an objective measure of pupil size and PRD (using the Pupillary Pain Index) before extubation. Pain ratings were obtained from patients after recovery of consciousness, while remifentanil was maintained at 2 ng/mL. A significant correlation was observed between NRS scores and pre-extubation PPI (rS = 0.62; P = 0.002), as well as between NRS scores and pupil diameter before tetanic stimulation PPI (rS = 0.56, P = 0.006). We also found a negative correlation between pupil diameter and age (rS = - 0.42, P = 0.04). The statistically significant correlation between pre-extubation PPI scores and NRS scores, as well as between the pupillary diameter before tetanic stimulation and NRS scores suggest the possibility of titrating analgesia at the end of the intraoperative period based on individual responses. This could allow clinicians to identify the ideal remifentanil concentration for the postoperative period. |
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Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational studyPupillary pain indexNociception monitoringPupillary refex dilationPostoperative painPupillary reflex dilation (PRD) is triggered by noxious stimuli and diminished by opioid administration. In the postoperative period, PRD has been shown to be correlated with pain reporting and a useful tool to guide opioid administration. In this study we assessed whether pupillary measurements taken before extubation were related with the patient's reported pain in the Post-Anesthesia Care Unit (PACU) using the Numerical Rating Scale (NRS). Our objective was to evaluate the correlation of PRD and pupillary variables measured intraoperatively with postoperative pain under the same opioid concentration. This was a prospective observational study of 26 neurosurgical patients undergoing general anesthesia exclusively with propofol and remifentanil. A portable infrared pupillometer was used to provide an objective measure of pupil size and PRD (using the Pupillary Pain Index) before extubation. Pain ratings were obtained from patients after recovery of consciousness, while remifentanil was maintained at 2 ng/mL. A significant correlation was observed between NRS scores and pre-extubation PPI (rS = 0.62; P = 0.002), as well as between NRS scores and pupil diameter before tetanic stimulation PPI (rS = 0.56, P = 0.006). We also found a negative correlation between pupil diameter and age (rS = - 0.42, P = 0.04). The statistically significant correlation between pre-extubation PPI scores and NRS scores, as well as between the pupillary diameter before tetanic stimulation and NRS scores suggest the possibility of titrating analgesia at the end of the intraoperative period based on individual responses. This could allow clinicians to identify the ideal remifentanil concentration for the postoperative period.This work was supported by the Fundação para a Ciência e Tecnologia under the projects SFRH/BD/98915/2013 and FCT-UID/EMS/50022/2013.SpringerRepositório AbertoVide, SérgioCastro, AnaCorreia, RuiCabral, TiagoLima, DeolindaNunes, Catarina S.Gambús, PedroAmorim, Pedro2023-07-29T00:30:22Z2020-07-292020-07-29T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.2/11446eng1387-130710.1007/s10877-020-00570-31573-2614info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-11-16T15:36:40Zoai:repositorioaberto.uab.pt:10400.2/11446Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T22:50:15.245303Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study |
title |
Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study |
spellingShingle |
Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study Vide, Sérgio Pupillary pain index Nociception monitoring Pupillary refex dilation Postoperative pain |
title_short |
Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study |
title_full |
Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study |
title_fullStr |
Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study |
title_full_unstemmed |
Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study |
title_sort |
Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study |
author |
Vide, Sérgio |
author_facet |
Vide, Sérgio Castro, Ana Correia, Rui Cabral, Tiago Lima, Deolinda Nunes, Catarina S. Gambús, Pedro Amorim, Pedro |
author_role |
author |
author2 |
Castro, Ana Correia, Rui Cabral, Tiago Lima, Deolinda Nunes, Catarina S. Gambús, Pedro Amorim, Pedro |
author2_role |
author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório Aberto |
dc.contributor.author.fl_str_mv |
Vide, Sérgio Castro, Ana Correia, Rui Cabral, Tiago Lima, Deolinda Nunes, Catarina S. Gambús, Pedro Amorim, Pedro |
dc.subject.por.fl_str_mv |
Pupillary pain index Nociception monitoring Pupillary refex dilation Postoperative pain |
topic |
Pupillary pain index Nociception monitoring Pupillary refex dilation Postoperative pain |
description |
Pupillary reflex dilation (PRD) is triggered by noxious stimuli and diminished by opioid administration. In the postoperative period, PRD has been shown to be correlated with pain reporting and a useful tool to guide opioid administration. In this study we assessed whether pupillary measurements taken before extubation were related with the patient's reported pain in the Post-Anesthesia Care Unit (PACU) using the Numerical Rating Scale (NRS). Our objective was to evaluate the correlation of PRD and pupillary variables measured intraoperatively with postoperative pain under the same opioid concentration. This was a prospective observational study of 26 neurosurgical patients undergoing general anesthesia exclusively with propofol and remifentanil. A portable infrared pupillometer was used to provide an objective measure of pupil size and PRD (using the Pupillary Pain Index) before extubation. Pain ratings were obtained from patients after recovery of consciousness, while remifentanil was maintained at 2 ng/mL. A significant correlation was observed between NRS scores and pre-extubation PPI (rS = 0.62; P = 0.002), as well as between NRS scores and pupil diameter before tetanic stimulation PPI (rS = 0.56, P = 0.006). We also found a negative correlation between pupil diameter and age (rS = - 0.42, P = 0.04). The statistically significant correlation between pre-extubation PPI scores and NRS scores, as well as between the pupillary diameter before tetanic stimulation and NRS scores suggest the possibility of titrating analgesia at the end of the intraoperative period based on individual responses. This could allow clinicians to identify the ideal remifentanil concentration for the postoperative period. |
publishDate |
2020 |
dc.date.none.fl_str_mv |
2020-07-29 2020-07-29T00:00:00Z 2023-07-29T00:30:22Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.2/11446 |
url |
http://hdl.handle.net/10400.2/11446 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
1387-1307 10.1007/s10877-020-00570-3 1573-2614 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Springer |
publisher.none.fl_str_mv |
Springer |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799135090402394112 |