Comparison of surgical pleth index-guided analgesia versus conventional analgesia technique in general anesthesia surgeries: A systematic review and meta-analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-28 DOI:10.1016/j.jclinane.2025.111800

Xi Xu , Xue-Feng Zhang , Zi-Hang Yu , Jian Liu , Liang Nie , Jian-Li Song

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Abstract

Objective

The objective of this study is to investigate whether the use of surgical pleth index (SPI)-guided intraoperative analgesia can result in a reduction in opioid consumption, intraoperative circulatory fluctuations, and the incidence of postoperative adverse reactions when compared to conventional analgesia techniques.

Methods

A comprehensive literature search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from the inception of these databases to November 2024. The objective was to identify randomized controlled trials that compared the use of SPI-guided analgesia with conventional analgesia practices in adult patients who underwent general anesthesia. The primary outcome was the intraoperative consumption of opioids, while intraoperative circulatory fluctuations, postoperative opioid consumption, pain scores, and adverse events served as secondary outcomes. Standardized mean differences (SMDs), weighted mean differences (WMDs) or pooled risk ratios (RRs) along with the corresponding 95 % confidence intervals (CIs) were employed for analysis.

Results

Fourteen studies were included in our meta-analysis. The pooled results indicated no significant difference in intraoperative opioid consumption between the SPI-guided analgesia group and the control group (SMD = 0.16, 95 % CI: −0.15 to 0.47, p = 0.33). However, SPI-guided analgesia was found to reduce intraoperative propofol dosage (SMD = −0.31, 95 % CI: −0.54 to −0.08, p = 0.008), prevent intraoperative tachycardia (RR = 0.50, 95 % CI: 0.30 to 0.85, p = 0.011), and significantly shorten the eye-opening time (WMD = −1.89, 95 % CI: −2.47 to −1.31, p < 0.001). No statistically significant differences were observed in extubation time, postoperative nausea and vomiting, pain scores, or postoperative opioid consumption.

Conclusions

Compared to the conventional analgesia group, SPI-guided analgesia does not reduce intraoperative opioid consumption in adult patients undergoing general anesthesia.

Trial registration: The protocol for this meta-analysis has been registered in PROSPERO (CRD42024611690).

查看原文本刊更多论文

手术体积指数引导镇痛与常规镇痛技术在全麻手术中的比较：系统回顾和荟萃分析

目的本研究的目的是探讨与传统镇痛技术相比，使用外科手术体积指数（SPI）引导术中镇痛是否能减少阿片类药物的消耗、术中循环波动和术后不良反应的发生率。方法对PubMed、Embase、Web of Science、Cochrane Library等数据库自建成以来至2024年11月进行综合文献检索。目的是确定随机对照试验，比较在接受全身麻醉的成年患者中使用spi引导的镇痛与传统的镇痛方法。主要结局是术中阿片类药物的消耗，而术中循环波动、术后阿片类药物消耗、疼痛评分和不良事件是次要结局。采用标准化平均差异（SMDs）、加权平均差异（wmd）或合并风险比（rr）以及相应的95%置信区间（ci）进行分析。结果14项研究被纳入我们的荟萃分析。合并结果显示，spi引导镇痛组术中阿片类药物用量与对照组无显著差异（SMD = 0.16, 95% CI: - 0.15 ~ 0.47, p = 0.33）。然而，spi引导下镇痛可减少术中异丙酚用量（SMD = - 0.31, 95% CI: - 0.54 ~ - 0.08, p = 0.008），防止术中心动心动（RR = 0.50, 95% CI: 0.30 ~ 0.85, p = 0.011），显著缩短开眼时间(WMD = - 1.89, 95% CI: - 2.47 ~ - 1.31, p <；0.001)。拔管时间、术后恶心呕吐、疼痛评分或术后阿片类药物消耗方面均无统计学差异。结论与常规镇痛组相比，spi引导下的镇痛不能减少成人全麻患者术中阿片类药物的消耗。试验注册：该荟萃分析的方案已在PROSPERO注册（CRD42024611690）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.