The Correlation of the Perfusion Index with Pain Scales in Infants Undergoing Surgery
Abstract
Background: The Perfusion Index (PI) is considered an important tool for evaluating the condition of infants, but there are few studies on the correlation between PI and pain assessment in infants. Therefore, this study aimed to investigate the correlation between PI and pain scale in infants undergoing surgery. Materials and Methods: This prospective, cross‑sectional study was conducted in the Neonatal Intensive Care Unit (NICU) of the Children’s Medical Center in Tehran, Iran, between April 2020 and April 2023. Using the Crying Requires, Oxygen, Increased vital signs, Expression, and Sleeplessness and right‑hand mean PI, using a Masimo pulse oximeter, pain scales were recorded immediately after surgery in the NICU and every 4 h for a total of 24 h by a skilled nurse unaware of the study. The correlation between PI and factors such as age, weight, NICU admission length, and pain scale was analyzed. Results: Our study found an inverse correlation between the pain scale and PI (p < 0.05; r: −0.385). Additionally, age, gestational age, and PI had a positive correlation with weight (p < 0.05; r: 0.233, 0.132, and 0.044, respectively). The age of the infant was also correlated with PI (p < 0.05; r: 0.307). Moreover, NICU admission length was inversely related to the PI scale (p < 0.05; r: −0.119).m Conclusions: The ease of use and objective measurement method of the PI makes it a valuable nursing tool for pain measurement in infants, in addition to other methods. However, further studies are needed to confirm the effectiveness of this correlation.
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Saeedi M, Sangsari R, Mirnia K, Ghanbari M. Normal value of perfusion index in healthy neonates born in Iran. Arch Iran Med 2024;27:606 10.
Piasek CZ, Van Bel F, Sola A. Perfusion index in newborn infants: A noninvasive tool for neonatal monitoring. Acta Paediatr 2014;103:468 73.
Hariharan D, Balasubramanian L, Kannappan V, Veluswami G. Perfusion index used as a sixth vital sign in preterm infants leads to earlier diagnosis of shock, better outcomes. Pediatrics 2018;141:548.
Alderliesten T, Lemmers PM, Baerts W, Groenendaal F, van Bel F. Perfusion index in preterm infants during the first 3 days of life: Reference values and relation with clinical variables. Neonatology 2015;107:258 65.
Mandala VK, Mendu SB, Bollaboina SK, Kotha R. Role of perfusion index and pulse variability index in the assessment of neonatal hemodynamics: A systematic review. Cureus 2023;15:e48058.
Mathew J, Bada Shekarappa C, Padubidri Nanyam Rao S. Correlation between perfusion index and CRIB scale in sick infants admitted to a tertiary center. J Trop Pediatr 2019;65:84 9.
Saleh AN, Mostafa RH, Hamdy AN, Hafez AF. Pulse oximetry derived perfusion index as a predictor of the efficacy of rescue analgesia after major abdominal surgeries. Open Anesth J 2020;14:101 7.
Luo F, Zhu H, Mei L, Shu Q, Cheng X, Chenet X, et al. Evaluation of procedural pain for neonates in a neonatal intensive care unit: A single centre study. BMJ Paediatr Open 2023;7:e002107.
Tapar H, Suren M, Karaman S, Dogru S, Karaman T, Sahin A, et al. Evaluation of the perfusion index according to the visual analog scale in postoperative patients. Saudi Med J 2018;39:1006 10.
Williams MD, Lascelles BD. Early neonatal pain—a review of clinical and experimental implications on painful conditions later in life. Front Pediatr 2020;8:30.
Witt N, Coynor S, Edwards C, Bradshaw H. A guide to pain assessment and management in the neonate. Curr Emerg Hosp Med Rep 2016;4:1 10.
Kupeli I, Kulhan NG. Can perfusion index be used as an objective tool for pain assessment in labor analgesia? Pak J Med Sci 2018;34:1262 6.
Chu CL, Huang YY, Chen YH, Lai LP, Yeh HM. An observational study: The utility of perfusion index as a discharge criterion for pain assessment in the postanesthesia care unit. PLoS One 2018;13:e0197630.
Ahmed A, Lotfy A, Elkholy J, Abdelhamid B, Ollaek M. Perfusion index as an objective measure of postoperative pain in children undergoing adenotonsillectomy: A cohort study. J Clin Monit Comput 2022;36:795 801.
Hasanin A, Mohamed SA, El adawy A. Evaluation of perfusion index as a tool for pain assessment in critically ill patients. J Clin Monit Comput 2017;31:961 5.
Giordano V, Deindl P, Gal E, Unterasinger L, Fuiko R, Steinbauer P, et al. Pain and neurodevelopmental outcomes of infants born very preterm. Dev Med Child Neurol 2023;65:1043 52.
Llerena A, Tran K, Choudhary D, Hausmann J, Goldgof D, Sun Y, Prescott SM. Neonatal pain assessment: Do we have the right tools? Front Pediatr 2023;10:1022751.
Pillai Riddell R, Fitzgerald M, Slater R, Stevens B, Johnston C, Campbell Yeo M. Using only behaviours to assess infant pain: A painful compromise? Pain 2016;157:1579 80.
Valitalo PA, van Dijk M, Krekels EH, Gibbins S, Simons SH, Tibboel D, et al. Pain and distress caused by endotracheal suctioning in neonates is better quantified by behavioural than physiological items: A comparison based on item response theory modelling. Pain 2016;157:1611 7.
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