ORIGINAL ARTICLE   Free access

Minerva Anestesiologica 2019 April;85(4):358-65

DOI: 10.23736/S0375-9393.18.12954-3

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Comparison of Surgical Pleth Index-guided analgesia using fentanyl versus conventional analgesia technique in laparoscopic cholecystectomy

Neetu JAIN ¹ ✉, Anjali GERA ¹, Bimla SHARMA ¹, Jayashree SOOD ¹, Parul CHUGH ²

¹ Department of Anesthesiology, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India; ² Department of Research, Sir Ganga Ram Hospital, New Delhi, India

BACKGROUND: Surgical Pleth Index (SPI) is an objective index and reflects the patient’s nociception-antinociception balance during surgery. There are few studies on clinical implication of use of SPI in laparoscopic surgery. The aim of this study was to compare fentanyl requirement using SPI guided administration versus conventional analgesia technique in laparoscopic cholecystectomy.
METHODS: One hundred forty patients of ASA physical status I and II, scheduled to undergo laparoscopic cholecystectomy were randomly allocated to SPI group and control group. In SPI group, fentanyl boluses of 0.5 mcg/kg were administered to keep SPI between a range of 20 to 50. In control group, fentanyl boluses 0.5 mcg/kg were given whenever heart rate or mean arterial pressure rose 20% above baseline. Intraoperative heart rate, blood pressure, fentanyl requirement, duration of surgery and recovery time were noted. SPI was monitored only in SPI group. Postoperative Visual Analog Scale (VAS) score, fentanyl requirement, postoperative nausea, vomiting and respiratory depression were recorded.
RESULTS: Mean intraoperative fentanyl consumption was significantly higher in SPI group as compared to control group (169±47.2 vs. 151±39.34, P=0.017). Hemodynamic changes and recovery time were comparable in both the groups. Post-operative VAS and adjuvant fentanyl consumption were significantly higher in control group as compared to SPI group (P<0.05). PONV and respiratory depression were comparable in both the groups.
CONCLUSIONS: Higher doses of fentanyl are required intraoperatively with lesser postoperative rescue analgesic requirements when SPI is used to guide intraoperative analgesia as compared to conventional analgesia technique.

KEY WORDS: Laparoscopy; Nociception; Fentanyl