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Foreseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational study

2020-07-29Journal article Open access
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dc.contributor.authorVide, Sérgio
dc.contributor.authorCastro, Ana
dc.contributor.authorCorreia, Rui
dc.contributor.authorCabral, Tiago
dc.contributor.authorLima, Deolinda
dc.contributor.authorNunes, Catarina S.
dc.contributor.authorGambús, Pedro
dc.contributor.authorAmorim, Pedro
dc.date.accessioned2021-11-30T16:22:16Z
dc.date.available2023-07-29T00:30:22Z
dc.date.issued2020-07-29
dc.description.abstractPupillary 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.pt_PT
dc.description.sponsorshipThis work was supported by the Fundação para a Ciência e Tecnologia under the projects SFRH/BD/98915/2013 and FCT-UID/EMS/50022/2013.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.doi10.1007/s10877-020-00570-3pt_PT
dc.identifier.eissn1573-2614
dc.identifier.issn1387-1307
dc.identifier.urihttp://hdl.handle.net/10400.2/11446
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.relationAdvanced Consciousness Assessment for Anaesthesia
dc.subjectPupillary pain indexpt_PT
dc.subjectNociception monitoringpt_PT
dc.subjectPupillary refex dilationpt_PT
dc.subjectPostoperative painpt_PT
dc.titleForeseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings: an observational studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.awardTitleAdvanced Consciousness Assessment for Anaesthesia
oaire.awardURIinfo:eu-repo/grantAgreement/FCT//SFRH%2FBD%2F98915%2F2013/PT
oaire.awardURIinfo:eu-repo/grantAgreement/FCT/5876/UID%2FEMS%2F50022%2F2013/PT
oaire.citation.endPage8pt_PT
oaire.citation.startPage1pt_PT
oaire.citation.titleJournal of clinical monitoring and computingpt_PT
oaire.fundingStream5876
person.familyNameVide
person.familyNameNunes
person.familyNameAmorim
person.givenNameSérgio
person.givenNameCatarina S.
person.givenNamePedro
person.identifier.ciencia-id691F-CDC2-E26A
person.identifier.orcid0000-0002-8185-2250
person.identifier.orcid0000-0002-8357-0994
person.identifier.orcid0000-0001-7466-4174
person.identifier.scopus-author-id55429654100
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.identifierhttp://doi.org/10.13039/501100001871
project.funder.nameFundação para a Ciência e a Tecnologia
project.funder.nameFundação para a Ciência e a Tecnologia
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
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