The value of pupillary diameter in evaluating pain perception after awakening in patients undergoing general anesthesia during orthopedic surgery
Abstract Background The pupillary response to tetanic electrical stimulation reflects the balance between nociceptive stimulation and analgesia. Although pupillary pain index (PPI) was utilized to predict postoperative pain, it depended on tetanic stimulation and was complex. We aim to describe the...
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| Format: | Article |
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BMC
2024-02-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-024-02428-6 |
| _version_ | 1827326457391611904 |
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| author | Huang Huang Yinuo Qiu Guoxin Gu Xiangyang Mei Liwei Pang Chuangxin Zhang Mingzi Ran Mengmeng Li |
| author_facet | Huang Huang Yinuo Qiu Guoxin Gu Xiangyang Mei Liwei Pang Chuangxin Zhang Mingzi Ran Mengmeng Li |
| author_sort | Huang Huang |
| collection | DOAJ |
| description | Abstract Background The pupillary response to tetanic electrical stimulation reflects the balance between nociceptive stimulation and analgesia. Although pupillary pain index (PPI) was utilized to predict postoperative pain, it depended on tetanic stimulation and was complex. We aim to describe the potential relationship between PD in the presence of surgical stimulation and pain levels after awakening. Methods According to the Verbal Rating Scale (VRS) score after extubation, the patients were divided into painless group (VRS = 0) and pain group (VRS ≥ 1). Pupillary diameter (PD) and pupillary light reflex velocity (PLRV) were compared between two groups when patients entered the operating room (T1), before incision (T2), 10 s after incision (T3), 30 s after incision (T4), 1 h after incision (T5), at the end of surgery (T6), shortly after extubation (T7), and when patients expressed pain clearly (T8). The magnitude of PD change (ΔPD) compared to the baseline value after anesthesia induction (T2) was calculated. The correlations between pupillary parameters and pain after awakening were calculated. Results Patients with VRS ≥ 1 had greater PD than painless patients at T3-7 (P = 0.04, 0.04, 0.003, <0.001, <0.001), and it was positively correlated with VRS score after awakening at T4-7 (r = 0.188, 0.217, 0.684, 0.721). The ability of T6ΔPD to predict VRS ≥ 1 was strong [threshold: 20.53%, area under the curve (AUC): 0.93, 95% confidence interval (CI): 0.89–0.97 ]. Conclusion Our study indicates that PD is a useful index to direct the individualized analgesics used during operation, to better avoid the occurrence of pain during the postoperative emergence period. Trial registration This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2000040908, registration date: 15/12/2020). |
| first_indexed | 2024-03-07T14:44:53Z |
| format | Article |
| id | doaj.art-9155573396844a03820dbf7ec7c3d344 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-07T14:44:53Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-9155573396844a03820dbf7ec7c3d3442024-03-05T20:05:03ZengBMCBMC Anesthesiology1471-22532024-02-012411710.1186/s12871-024-02428-6The value of pupillary diameter in evaluating pain perception after awakening in patients undergoing general anesthesia during orthopedic surgeryHuang Huang0Yinuo Qiu1Guoxin Gu2Xiangyang Mei3Liwei Pang4Chuangxin Zhang5Mingzi Ran6Mengmeng Li7Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical CollegeDepartment of Anesthesiology, the Fourth Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, the Fourth Medical Center of Chinese PLA General HospitalCenter for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical CollegeDepartment of Anesthesiology, the Fourth Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, the Fourth Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, the Fourth Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, the Fourth Medical Center of Chinese PLA General HospitalAbstract Background The pupillary response to tetanic electrical stimulation reflects the balance between nociceptive stimulation and analgesia. Although pupillary pain index (PPI) was utilized to predict postoperative pain, it depended on tetanic stimulation and was complex. We aim to describe the potential relationship between PD in the presence of surgical stimulation and pain levels after awakening. Methods According to the Verbal Rating Scale (VRS) score after extubation, the patients were divided into painless group (VRS = 0) and pain group (VRS ≥ 1). Pupillary diameter (PD) and pupillary light reflex velocity (PLRV) were compared between two groups when patients entered the operating room (T1), before incision (T2), 10 s after incision (T3), 30 s after incision (T4), 1 h after incision (T5), at the end of surgery (T6), shortly after extubation (T7), and when patients expressed pain clearly (T8). The magnitude of PD change (ΔPD) compared to the baseline value after anesthesia induction (T2) was calculated. The correlations between pupillary parameters and pain after awakening were calculated. Results Patients with VRS ≥ 1 had greater PD than painless patients at T3-7 (P = 0.04, 0.04, 0.003, <0.001, <0.001), and it was positively correlated with VRS score after awakening at T4-7 (r = 0.188, 0.217, 0.684, 0.721). The ability of T6ΔPD to predict VRS ≥ 1 was strong [threshold: 20.53%, area under the curve (AUC): 0.93, 95% confidence interval (CI): 0.89–0.97 ]. Conclusion Our study indicates that PD is a useful index to direct the individualized analgesics used during operation, to better avoid the occurrence of pain during the postoperative emergence period. Trial registration This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2000040908, registration date: 15/12/2020).https://doi.org/10.1186/s12871-024-02428-6Noxious stimulationPupillary diameterPupillary reflex dilationPupillary light reflex |
| spellingShingle | Huang Huang Yinuo Qiu Guoxin Gu Xiangyang Mei Liwei Pang Chuangxin Zhang Mingzi Ran Mengmeng Li The value of pupillary diameter in evaluating pain perception after awakening in patients undergoing general anesthesia during orthopedic surgery BMC Anesthesiology Noxious stimulation Pupillary diameter Pupillary reflex dilation Pupillary light reflex |
| title | The value of pupillary diameter in evaluating pain perception after awakening in patients undergoing general anesthesia during orthopedic surgery |
| title_full | The value of pupillary diameter in evaluating pain perception after awakening in patients undergoing general anesthesia during orthopedic surgery |
| title_fullStr | The value of pupillary diameter in evaluating pain perception after awakening in patients undergoing general anesthesia during orthopedic surgery |
| title_full_unstemmed | The value of pupillary diameter in evaluating pain perception after awakening in patients undergoing general anesthesia during orthopedic surgery |
| title_short | The value of pupillary diameter in evaluating pain perception after awakening in patients undergoing general anesthesia during orthopedic surgery |
| title_sort | value of pupillary diameter in evaluating pain perception after awakening in patients undergoing general anesthesia during orthopedic surgery |
| topic | Noxious stimulation Pupillary diameter Pupillary reflex dilation Pupillary light reflex |
| url | https://doi.org/10.1186/s12871-024-02428-6 |
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