Use of analgesia monitors to optimize the management of immediate postoperative pain.

1 Boselli E, Bouvet L, Bégou G, et al. Prediction of immediate post-operative pain using the analgesia/nociception index: a prospective observational study. Prospective observational study of the non-invasive assessment of immediate postoperative pain using the analgesia/nociception index (ANI). Pupillary reflex dilatation and analgesia nociception index monitoring to assess the effectiveness of regional anesthesia in children anesthetised with sevoflur-ane. Effect site concentrations of remifentanil and pupil response to noxious stimulation. Use of analgesia monitors to optimize the management of immediate postoperative pain Reply from the authors Editor—We read with great interest the letter by Ly-Liu and Reinoso-Barbero in response to our publication. 1 Similar to what we previously observed in adult patients using Analgesia/Nociception Index (ANI), the authors observed a significant correlation between the Pupillary Pain Index (PPI) and a behavioural paediatric pain scale (LLANTO scale) in children undergoing general anaesthesia using sevoflurane and remifentanil. This relationship was not observed with the PPI and Verbal Analogue Scale (VAS) pain scores, mostly because the VAS may be influenced by many factors other than pain in awake children, but also because young children may not use the VAS adequately. Monitoring analgesia is a new and very challenging concept and developing tools for the prediction of immediate post-operative pain may have an important impact in clinical practice. Indeed, it as been shown in a recent study that severe pain still occurs in 20–40% of patients, including patients undergoing so-called minor surgical procedures (appendec-tomy, tonsillectomy, etc.). 2 In this perspective, the use of analgesia monitors such as the ANI or PPI may provide useful information to physicians to optimize the management of immediate postoperative pain. It is postulated that ANI or PPI values immediately before extubation may be highly predictive of acute pain within the following minutes, thus the administration of a prophylactic dose of opioid may provide a reduction in pain scores at arrival in the post-anaesthetic care unit. This, however, remains to be demonstrated in prospective studies. For us, use of the ANI presents an advantage over the PPI since it allows for continuous analgesia monitoring directly from the patient monitor, whereas the PPI requires measuring the changes in pupil dilation in response to increasing electric stimulations. Moreover, in cephalic procedures such as ear– nose –throat surgery, the use of a device placed over the face is not possible. Nevertheless, the authors should be commended for performing this study in young children in …