• T Ledowski, M Schneider, M Gruenewald, R K Goyal, S R Teo, and J Hruby.
• University of Western Australia, Perth, Australia; Royal Perth Hospital, Perth, Australia. Electronic address: Thomas.ledowski@health.wa.gov.au.
• Br J Anaesth. 2019 Aug 1; 123 (2): e328-e332.

BackgroundReported outcome benefits after surgical pleth index (SPI, GE Healthcare, Helsinki, Finland) guided anaesthesia are conflicting. One potential explanation may be the lack of evidence for the selection of meaningful SPI target values. A recently published trial found an SPI cut-off of 30 as a 'best-fit' to predict moderate-to-severe acute postoperative pain. This prospective trial was designed to validate this target and to investigate the influence of patient age on SPI in this context.MethodsAfter ethics approval, 200 patients undergoing non-emergency surgery were enrolled. Data related to SPI, heart rate (HR), and mean arterial pressure (MAP) were recorded for the last 5 min of surgery, just before arousal. After admission to recovery, pain scores (numeric rating scale [NRS], 0-10) were obtained every 5 min for 15 min.ResultsThe data of 196 patients were analysed. Receiver-operating curve analysis showed a cut-off SPI value of 29 to be the optimum intraoperative target to discriminate between NRS 0-3 and 4-10. This confirms the 'best fit' cut-off for SPI published previously. Though still superior to HR and MAP, the sensitivity and specificity of the SPI were only poor. Age had no influence on the predictive accuracy of SPI.ConclusionsAn SPI of approximately 30 was confirmed as having the best sensitivity/specificity to predict moderate-to-severe pain in the postanaesthesia care unit. However, the predictive accuracy was overall poor and not influenced by patient age.Clinical Trial RegistrationACTRN12617001475336.Copyright © 2019 British Journal of Anaesthesia. All rights reserved.

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