Pupillary Pain Index-Guided Postoperative Pain Therapy in ENT Surgery: A Randomized Trial
Windpassinger M, Prusak M, Yeghiazaryan L, Ristl R, Ott S, Müller-Wirtz LM, Ruetzler K (2026)
Publication Type: Journal article
Publication year: 2026
Journal
Book Volume: 15
Article Number: 462
Journal Issue: 2
DOI: 10.3390/jcm15020462
Abstract
Background: Postoperative pain levels and opioid requirements vary considerably, even among patients undergoing similar surgical interventions. The pupillary pain index—a pupillometry-derived measure of nociception-antinociception balance—may help individualize postoperative analgesia. We therefore tested the hypothesis that a pupillary pain index-guided opioid titration at the end of surgery reduces postoperative pain and opioid consumption compared with standard care. Methods: At the end of surgery, a portable infrared pupilometer was used to measure pupillary dilation reflex during stepwise tetanic stimulation (10–60 mA), generating a pupillary pain index score. Adult patients undergoing elective ear-nose-throat surgery under general anesthesia were randomized to pupillary pain index-guided opioid therapy or standard care. Opioid administration in the pupillary pain index group followed predefined pupillary pain index cutoffs; in the control group, analgesia was managed per routine practice. Postoperative opioid consumption and pain—assessed using a numerical rating scale (NRS, 0–10)—were recorded every 30 min for 2 h in the post-anesthesia care unit. Linear models with covariates including remifentanil, weight, nose surgery, and sex were calculated to compare outcomes between groups. Results: Mean (±SD) opioid consumption during the first 2 postoperative hours was 4.9 ± 4.3 mg in the pupillary pain index-guided group and 6.5 ± 4.3 mg in the control group (adjusted p = 0.12). Mean pain scores were 2.0 ± 1.1 and 2.6 ± 1.4, respectively (adjusted p = 0.10). Conclusions: Pupillary pain index-guided analgesia resulted in a nearly 25% reduction in opioid consumption and lower pain scores, although not statistically significant. This suggests that PPI-guided analgesia is not inferior to standard care in terms of pain management.
Involved external institutions
Austria (AT)How to cite
APA:
Windpassinger, M., Prusak, M., Yeghiazaryan, L., Ristl, R., Ott, S., Müller-Wirtz, L.M., & Ruetzler, K. (2026). Pupillary Pain Index-Guided Postoperative Pain Therapy in ENT Surgery: A Randomized Trial. Journal of Clinical Medicine, 15(2). https://doi.org/10.3390/jcm15020462
MLA:
Windpassinger, Marita, et al. "Pupillary Pain Index-Guided Postoperative Pain Therapy in ENT Surgery: A Randomized Trial." Journal of Clinical Medicine 15.2 (2026).
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