Monitoring electrical skin conductance: a tool for the assessment of postoperative pain in children?

Abstract

Funding: Princess Margaret Hospital Foundation, Perth, AustraliaThe manuscript has been written and checked according to the STROBE consensus.Objectives: To test whether changes in electrical skin conductance are a suitable tool for the assessment of postoperative pain in paediatric patients.Design: Prospective, blinded observational study.Setting: Recovery room Department of Anaesthesia, Princess Margaret Hospital for Children, Australia.Participants: A total of 180 postoperative paediatric patients aged 1–16 years.Main Outcome Measures: Area under the curve (ROC) for the skin conductance parameter ‘number of fluctuation per second’ (NFSC) to distinguish between no or mild vs moderate or severe postoperative pain (obtained by standard pain scores).Results: Postoperative pain was assessed in 165 children (1–16 years) by standard validated clinical pain assessment tools (Revised Faces Scale, FLACC Scale, Visual Analogue Scale) at various time points during their stay in the recovery room. NFSC was recorded simultaneously. Fifteen patients were excluded due to technical problems with monitoring NFSC. The area under the Receiver Operating Characteristic (ROC) curve for predicting moderate to severe pain from NFSC was 0.82 (95% CI, 0.79–0.85). Over all age groups, a NFSC cut‐off value of 0.13 was found to distinguish between no or mild vs moderate or severe pain with a sensitivity of 90% and a specificity of 64% (positive predictive value 35%, negative predictive value 97%).Conclusion: NFSC accurately predicts moderate to severe pain in postoperative paediatric patients. In this group of patients, the measurement of NFSC may therefore be a useful addition to the presently used, clinical pain assessment tools.Trial Registration: Australian Clinical Trials Register (ACTRN12607000474459)