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Application of SPI-guided analgesia in laparoscopic gynecologic surgery: a randomized controlled trial evaluating the remifentanil-sparing effect and predictive value of time-weighted SPI.

Wei Liu·Ying Li·Ran Lin·Min Ke·Qin Lin·Wei Lin·Shu Zheng·Xiangfeng Wang
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Abstract

This study aimed to achieve two primary objectives: (1) to evaluate the opioid-sparing effect of Surgical Pleth Index (SPI)-directed analgesia during surgery via a randomized controlled trial (RCT), and (2) to propose and preliminarily assess a novel dynamic metric, Threshold-based Time-Weighted SPI (Tb-TW-SPI), which integrates stimulus intensity and duration, for its predictive efficacy regarding postoperative moderate-to-severe pain. Employing an RCT combined with exploratory analysis, 61 patients undergoing elective laparoscopic gynecologic surgery were randomized into an SPI-directed analgesia group or a conventional analgesia group. The primary outcome was total intraoperative remifentanil consumption. Postoperatively, an exploratory analysis of the control group data evaluated the correlation between Tb-TW-SPI and Numeric Rating Scale (NRS) pain scores in the post-anesthesia care unit (PACU), calculating its predictive value for moderate-to-severe pain (NRS ≥ 4). Results: The SPI-directed group required significantly less intraoperative remifentanil than the conventional group [median (IQR): 5.84(5.02,6.62)vs. 6.96(5.81,8.19)µg/kg/h; P = 0.016]. Postoperative pain scores did not differ significantly between groups (P > 0.05). Exploratory analysis of the conventional analgesia group revealed that Tb-TW-SPI values were significantly higher in patients with moderate-to-severe postoperative pain (NRS ≥ 4) compared to those without (P = 0.0417).The area under the ROC curve for Tb-TW-SPI predicting this pain was 0.74 (95% CI: 0.52-0.96), with 67% sensitivity and 76% specificity at an optimal cutoff of 1210. This RCT suggests that SPI-directed analgesia can safely and moderately reduce intraoperative remifentanil consumption. Furthermore, the proposed Tb-TW-SPI metric, in this exploratory analysis, suggests potential for predicting postoperative pain, though this finding requires validation in larger cohorts with higher-frequency SPI sampling, offering a new direction for SPI interpretation. Large-scale, multicenter trials are warranted to validate the predictive utility of Tb-TW-SPI. Clinical Trial Registration, China Clinical Trial Registry: ChiCTR2400088444.

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HumansFemaleRemifentanilGynecologic Surgical ProceduresLaparoscopyPostoperative PainPain MeasurementMiddle AgedAdultAnalgesics, OpioidAnalgesiaROC CurveTreatment OutcomePain ManagementInjurious stimuliPostoperative painSurgical pleth indexTime-weighted indexJournal ArticleRandomized Controlled Trial

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Wei Liu, Ying Li, Ran Lin, Min Ke, Qin Lin, Wei Lin, Shu Zheng, Xiangfeng Wang. 2026-06-08. Application of SPI-guided analgesia in laparoscopic gynecologic surgery: a randomized controlled trial evaluating the remifentanil-sparing effect and predictive value of time-weighted SPI.. https://doi.org/10.1007/s10877-026-01452-w

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Journal Article; Randomized Controlled Trial resourceAdult subjectAnalgesia subjectAnalgesics, Opioid subjectFemale subjectGynecologic Surgical Procedures subjectHumans subjectJournal Article subjectLaparoscopy subjectMiddle Aged subjectPain Management subjectPain Measurement subjectRandomized controlled trials study

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