title: Postoperative pain assessment in children: a pilot study of the usefulness of the analgesia nociception index.
abstract: BACKGROUND
  The ability to perform objective pain assessment is very important in paediatric patients. The goal of this study was to investigate the relationship between the analgesia nociception index (ANI), which is based on the heart rate variability, and objective measurements of pain intensity in young or cognitively impaired children, after surgical or imaging procedures (control group) under general anaesthesia.
  
  
  METHODS
  On arrival in the recovery room and subsequently at 5-10 min intervals, the level of pain was rated using the FLACC pain scale (0-10). The ANI values (0-100; 0 indicating the worst pain) were recorded simultaneously. The area under the receiver operating characteristic curve (AUC) and grey zone approach were used to evaluate the performance of the ANI to detect patients with FLACC >4. Instantaneous ANI values were compared with ANI values averaged over 256 s periods of time.
  
  
  RESULTS
  All children in the surgical group (n=32) developed moderate-to-severe pain (FLACC >4). Children in the control group (n=30) exhibited minimal pain. Instantaneous ANI values were lower in children of the surgical group than in the control group [52 (sd16) vs 69 (16), P<0.001]. The AUC for the 256 s ANI recording period [0.94 (95% confidence interval 0.85-0.99)] was significantly higher than for instantaneous ANI (P<0.05). When measured for a period of 256 s, an ANI cut-off value of 56 (grey zone [58-60]) was most predictive of a FLACC ≥4.
  
  
  CONCLUSIONS
  The ANI may provide an objective measurement of acute postoperative pain, which is correlated with that measured on a FLACC scale in young or cognitively impaired children.
authors.affiliation: Service d'Anesthésie Réanimation. Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, Paris 75743, France.
authors.forename: O
authors.initials: O
authors.lastname: Gall
authors.affiliation: Service d'Anesthésie Réanimation. Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, Paris 75743, France.
authors.forename: B
authors.initials: B
authors.lastname: Champigneulle
authors.affiliation: Service d'Anesthésie Réanimation. Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, Paris 75743, France.
authors.forename: B
authors.initials: B
authors.lastname: Schweitzer
authors.affiliation: Service d'Anesthésie Réanimation. Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, Paris 75743, France.
authors.forename: T
authors.initials: T
authors.lastname: Deram
authors.affiliation: Service d'Anesthésie Réanimation. Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, Paris 75743, France.
authors.forename: O
authors.initials: O
authors.lastname: Maupain
authors.affiliation: Service d'Anesthésie Réanimation. Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, Paris 75743, France.
authors.forename: J
authors.initials: J
authors.lastname: Montmayeur Verchere
authors.affiliation: Service d'Anesthésie Réanimation. Hôpital Universitaire Necker - Enfants Malades, Université Paris Descartes, Assistance Publique Hôpitaux de Paris, 149 rue de Sèvres, Paris 75743, France gilles.orliaguet@nck.aphp.fr.
authors.forename: G
authors.initials: G
authors.lastname: Orliaguet
mesh_terms: D000293:Adolescent; D000698:Analgesia / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003147:Communication Disorders / Q000503:physiopathology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D008297:Male; D059225:Nociception / Q000502:physiology*; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000503:physiopathology; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D015203:Reproducibility of Results
keywords: analgesia, paediatric; children; pain, paediatric; parasympathetic nervous system