Pulse-oximetry Derived Perfusion Index as a Predictor of the Efficacy of Rescue Analgesia After Major Abdominal Surgeries

Ashraf Nabil Saleh1
, Raham Hasan Mostafa1, *
, Ahmad Nabil Hamdy1, 2
, Amr Fouad Hafez1

1 Department of Anaesthesia, Intensive Care and Pain Management, Ain Shams University, Cairo, Egypt
2 Department of Anaesthesia, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates

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Creative Commons License
© 2020 Saleh et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Anaesthesia, Intensive Care and Pain Management, Ain Shams University, El-hay El-Sabee, Nasr City, Cairo, Egypt; Tel: 002/01222530020; E-mail:


Study Objective:

The use of an easy to apply reliable tool is essential to assess pain in patients in intensive care units. This study aimed primarily to evaluate perfusion index usefulness as an objective indicator of pain.

Methods and Measurements:

Data were collected from 40 non-intubated adult patients admitted to the surgical intensive care unit postoperatively. The Masimo pulse co-oximetry perfusion index (PI) probe was attached to the patient. At the time of the first request for analgesia (T1), the Behavioural pain scale non-intubated scoring system (BPS-NI) was recorded with the PI and patients' haemodynamics following which rescue analgesia was given. Thirty minutes thereafter (T2), second measurements for the mentioned parameters were taken.

Main Results:

There was a statistically significant reduction in the BPS-NI score, blood pressure and heart rate after analgesic administration (P-values, <0.001, 0.039 and 0.001, respectively), together with a significant increase in the PI (P-value, 0.004). This means that the PI increases with adequate relief from pain, as indicated by a decrease in BPS-NI score and haemodynamics, but the correlation was not statistically significant between their changes.


There was no statistically significant correlation between the PI and the pain score or other clinical indicators of pain either before or after the administration of analgesic.

Keywords: Behavioural pain scale non-intubated, Major abdominal surgery, Masimo, Perfusion index, Postoperative pain, Pulse oximetry.