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Pain assessment in the postanaesthesia care unit using pupillometry. A cross-sectional study after standard anaesthetic care.

Elie Kantor 1, 2 Philippe Montravers 1, 2 Dan Longrois 1, 2 Jean Guglielminotti 1, 2
2 UMR-S 738 INSERM
U738 / UMR_S738 - Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques, Service d'anesthésie - réanimation chirurgicale
Abstract : BACKGROUND Patients assess their own pain with a numerical rating scale (NRS). In the postanaesthesia care unit (PACU), NRS helps to determine and monitor analgesic administration, but is useless in patients who are unable to communicate. In non-PACU patients, acute pain increases pupillary diameter and pupillary light reflex amplitude (PLRA), the difference between pupillary diameter before and after light stimulation. OBJECTIVES To study the association between postopera-tive pain (NRS) and pupillary diameter or PLRA in PACU patients after routine anaesthetic care. DESIGN Cross-sectional cohort study. SETTING Bichat-Claude Bernard Hospital, Paris. PATIENTS One hundred and forty-five patients undergoing planned surgery under general anaesthesia. INTERVENTIONS NRS, pupillary diameter and PLRA were measured on arrival in the PACU. When NRS was more than 4, intravenous morphine titration was started and a second measurement performed. MAIN OUTCOME MEASURES Association between NRS and pupillary diameter or PLRA was assessed with Pearson correlation coefficient (r) as was association between changes in these variables after morphine titration. RESULTS Mean NRS was 4.7, and was more than 4 in 79 patients (55%). No statistically significant association was observed between NRS and pupillary diameter (r ¼ 0.10, P ¼ 0.54) or PLRA (r ¼ 0.03, P ¼ 0.72). Twenty-seven patients (19%) received morphine titration with significant decreases in NRS, pupillary diameter and PLRA afterwards. No association was observed between NRS changes and pupillary diameter or PLRA changes. CONCLUSION Acute postoperative pain is not associated with pupillary diameter or PLRA. Further research is required to develop tools to assess pain in the PACU.
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Submitted on : Tuesday, November 18, 2014 - 11:51:23 PM
Last modification on : Wednesday, August 19, 2020 - 11:18:07 AM
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Elie Kantor, Philippe Montravers, Dan Longrois, Jean Guglielminotti. Pain assessment in the postanaesthesia care unit using pupillometry. A cross-sectional study after standard anaesthetic care.. European Journal of Anaesthesiology, Lippincott, Williams & Wilkins, 2013, pp.91-97. ⟨10.1097/01.EJA.0000434966.96165.c9⟩. ⟨inserm-01084308⟩

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