Intraoperative Nociception and Postoperative Pain
Condition: Pain, Postoperative; Nociceptive Pain; Analgesics
MeSH terms: Pain, Postoperative; Nociceptive Pain
Study type: Observational

Summary: 
      If the individual patient's pain is assessed and the amount of analgesic needed after surgery
      is predicted, appropriate injection of pain control and excessive injection of narcotic
      analgesic can be prevented. Therefore, investigators try to evaluate the relation
      intraoperative nociception response with postoperative pain score.

      In similar anesthetic depth(End tidal sevoflurane 3%) , changes of surgical pleth index
      values for stimulus of skin incision are thought to reflect the individual nociception
      characteristics.
    

Detailed description: 
      Patients who undergoing upper abdominal laparotomy surgery usually experience severe
      postoperative pain. Previous studies were reported that preoperative pain, young age,
      high-dose remifentanil, and depression were associated with severe postoperative pain.

      However, anesthesia-related studies were either retrospective studies or injected with
      anesthetic agents in excess of clinical doses to differentiate between groups. There is no
      objective indicator for prediction severe postoperative pain.The purpose of this study was to
      investigate the relationship between intraoperative pain response and postoperative pain on
      standardized surveillance devices.

      To maintain the depth of anesthesia, an EEG monitoring device bispectral index (BIS) is used.
      Also, surgical pleth index (SPI, GE healthcare, Freiburg, Germany) is a noninvasive
      pain-analgesia balance monitoring device that is commercially available to evaluate the state
      of pain during general anesthesia. SPI = 100- (0.3 * heart beat interval + 0.7 *
      photoplethysmographic pulse wave amplitude) is automatically and continuously calculated from
      the waveform of peripheral oxygen saturation.

      In similar anesthetic depth(End tidal sevoflurane 3%) , changes of SPI values for stimulus of
      skin incision are thought to reflect the individual nociception characteristics. The
      investigators hypothesized the higher analgesics consumption can predict with high SPI
      response following incisional stimuli.

      Thus, investigators try to evaluate the comparison of two groups ( high fentanyl consumption
      group vs. low fentanyl consumption group) with intraoperative SPI value (incision and before
      aurosal) and hemodynamic parameters under End tidal sevoflurane 3%(anesthesia depth,
      hemodynamically stable and appropriate anesthetic depth based on previous studies were
      confirmed at the time of skin incision). And the characteristics and emotional status of
      patients in two groups are compared.
    

Intervention name(s): SPI group
Intervention type(s): Device
Intervention description(s): All patients applied surgical pleth index at the time of surgical incision, under End tidal Sevoflurane 3%
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        the 20-80 year old patients who undergoing lapatotomy gastrectomy at samsung medical center