Clinical Study Of PTi In The Pain And Nociception Monitoring Of Patients Undergoing Radical Gastrectomy

Objective: To investigate the efficiency of PTi for monitoring nociceptive stimulation and pain during radical gastrectomy,and whether its numerical changes can reflect the anti-nociceptive effect of opioid analgesics use.The differences of PTi,surgical pleth index(SPI),Pain index(Pi)and hemodynamic parameters in monitoring nociceptive stimulation and their response to anti-nociceptive effect of sufentanil were compared.Methods: 89 patients undergoing radical gastrectomy were enrolled in this investigation.The patients were anesthetized by general anesthesia and the intraoperative analgesic protocal were determined by the chief anesthesiologist.The PTi,wavelet index(WLi),surgical pleth index(SPI),pain index(Pi),systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR)values were recorded and analyzed at the time as follows: preoperative,immediately before intubation,maximum value changed within 3 minutes after intubation,immediately before skin incision,maximum value changed within 3 minutes after skin incision,immediately before establishment of pneumoperitoneum,maximum value changed within 3 minutes after establishment of pneumoperitoneum,immediately before abdominal irrigation,maximum value changed within 3 minutes after abdominal irrigation,immediately before the use of analgesics and minimum value changed within 3 minutes after the use of analgesics for four times during operation.The type of operation,the length of operation,the volume of fluid infusion and bleeding during operation,the score of pain in the recovery room after operation,the total consumption of analgesics,and the remedial measures of analgesia were recorded.Results: PTi changed significantly after intubation,skin incision and abdominal irrigation(P < 0.0001).The area under AUC curve of PTi at intubation,skin incision,establishment of pneumoperitoneum and abdominal irrigation are 0.743;0.781;0.758;0.793,indicate that PTi can be used as an effective index for predicting nociceptive stimulation.PTi index decreased significantly at first three times use of analgesics(P = 0.0028;P = 0.0016;P = 0.0016),which is similar to SPI,while SBP,DBP,MAP,HR and Pi did not change significantly.The correlation analysis shows that the Pi and NRS score are closely correlated after recovery,and Pearson correlation coefficient was 0.7776(P < 0.001).There was no significant change in PTi after pneumoperitoneum establishment(P= 0.0195).PTi responsiveness after intubation,skin incision,establishment of pneumoperitoneum and irrigation stimulation was less than SPI(AUC = 0.911;0.973;0.925;0.851).Conclusions: PTi can reflect the changes of nociceptive stimulation in patients undergoing radical gastrectomy,and it decreased significantly with the application of sufentanil.PTi and SPI are comparable in monitoring the use of analgesics during operation,and they are both superior to the traditional hemodynamic parameters.Pi after awakening from anesthesia is significantly correlated with NRS score,indicates that it can be used to evaluate the subjective pain of patients.