Perfusion index in the follow-up of postoperative pain: hypertensive patient sample

Background: The relative changes in perfusion index following postoperative analgesia were investigated. The study also aimed to investigate the ability of perfusion index to predict analgesic requirements. As a secondary aim, the results of the relative changes in perfusion index in individuals with hypertension were analyzed. Methods: A total of 100 patients with American Society of Anesthesiologists (ASA) 1–3 with or without hypertension who were scheduled to undergo open abdominal surgery between 01 April 2023 and 30 November 2023 were included in the study. The relative variability of visual analogue scale and perfusion index in patients receiving postoperative analgesia was examined. We also studied at which these variables predicted postoperative pain following rescue analgesia. The patients with hypertension were analysed alongside other patient groups. Results: The relative change in perfusion index was found to have a higher ability to predict the need for analgesia in patients with high postoperative Visuel Analogue Scale (VAS) scores. This ability was found to be increased in patients with hypertension. The number of patients with moderate to high pain (VAS >6) in the postoperative period was found to be 86. Conclusions: The area under the Receiver Operating Characteristic (ROC) curve was found to have a sensitivity of 64% with a positive predictive value of 86%. Therefore relative changes in perfusion index can be used as a method to predict postoperative pain. Clinical Trial Registration: Protocol ID: 76988455-050, Identification No NCT06535581.

Perfusion index; Postoperative pain; Hypertension

[1] Argüello-Prada EJ, Molano Valencia RD. On the use of indexes derived from photoplethysmographic (PPG) signals for postoperative pain assessment: a narrative review. Biomedical Signal Processing and Control. 2023; 80: 104335.

[2] Abdelnasser A, Abdelhamid B, Elsonbaty A, Hasanin A, Rady A. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index. British Journal of Anaesthesia. 2017; 119: 276–280.

[3] Chu CL, Huang YY, Chen YH, Lai LP, Yeh HM. An observational study: the utility of perfusion index as a discharge criterion for pain assessment in the postanesthesia care unit. PLOS ONE. 2018; 13: e0197630.

[4] Kamel AAF, Medhat MM, Salem DAE, Naby SMA. Effect of perioperative magnesium sulfate and labetalol infusion on peripheral perfusion and postoperative pain in nasal surgery: a randomized controlled trial. Patient Safety in Surgery. 2022; 16: 27.

[5] Elshal MM, Hasanin AM, Mostafa M, Gamal RM. Plethysmographic peripheral perfusion index: could it be a new vital sign? Frontiers in Medicine. 2021; 8: 651909.

[6] Min JY, Chang HJ, Chu SJ, Chung MY. The perfusion index of the ear as a predictor of hypotension following the induction of anesthesia in patients with hypertension: a prospective observational study. Journal of Clinical Medicine. 2022; 11: 6342.

[7] Kim D, Lee C, Bae H, Kim J, Oh EJ, Jeong JS. Comparison of the perfusion index as an index of noxious stimulation in monitored anesthesia care of propofol/remifentanil and propofol/dexmedetomidine: a prospective, randomized, case-control, observational study. BMC Anesthesiology. 2023; 23: 183.

[8] Ahmed A, Lotfy A, Elkholy J, Abdelhamid B, Ollaek M. Perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy: a cohort study. Journal of Clinical Monitoring and Computing. 2022; 36: 795–801.

[9] Schober P, Boer C, Schwarte LA. Correlation coefficient: appropriate use and interpretation. Anesthesia and Analgesia. 2018; 126: 1763–1768.

[10] Sertcakacilar G, Çetingök H, Sabaz MS, Yener YZ, Atiç E, Eren G, et al. Evaluation of block success in patients undergoing ultrasound-guided infraclavicular brachial plexus block with bilateral upper extremity perfusion index. Indian Journal of Surgery. 2022; 84: 510–516.

[11] Kuroki C, Godai K, Hasegawa-Moriyama M, Kuniyoshi T, Matsunaga A, Kanmura Y, et al. Perfusion index as a possible predictor for postanesthetic shivering. Journal of Anesthesia. 2014; 28: 19–25.

[12] Joachim J, Coutrot M, Millasseau S, Matéo J, Mebazaa A, Gayat E, et al. Real-time estimation of mean arterial blood pressure based on photoplethysmography dicrotic notch and perfusion index. A pilot study. Journal of Clinical Monitoring and Computing. 2021; 35: 395–404.

[13] Toyama S, Kakumoto M, Morioka M, Matsuoka K, Omatsu H, Tagaito Y, et al. Perfusion index derived from a pulse oximeter can predict the incidence of hypotension during spinal anaesthesia for Caesarean delivery. British Journal of Anaesthesia. 2013; 111: 235–241.

[14] Xu Z, Xu T, Zhao P, Ma R, Zhang M, Zheng J. Differential roles of the right and left toe perfusion index in predicting the incidence of postspinal hypotension during cesarean delivery. Anesthesia and Analgesia. 2017; 125: 1560–1566.

[15] Bihani P, Pandey A, Jha M, Paliwal N, Jaju R, Solanki R. Comparing perfusion index and visual analogue scores for postoperative pain assessment following upper limb surgeries under supraclavicular brachial plexus block: an observational study. Cureus. 2024; 16: e55529.

[16] Lima A, Bakker J. Noninvasive monitoring of peripheral perfusion. Intensive Care Medicine. 2005; 31: 1316–1326.

[17] Tapar H, Karaman S, Dogru S, Karaman T, Sahin A, Tapar GG, et al. The effect of patient positions on perfusion index. BMC Anesthesiology. 2018; 18: 111.