Using the Surgical Plethysmography Index and Pupillometry to Guide Nociception Management in Pediatric Spine Surgery: A Case Report.

Effective perioperative pain management requires a multimodal approach using clinical, physiologic, and pharmacologic monitoring techniques. The surgical plethysmography index (SPI) and digital pupillometry are promising tools for assessing nociception and sympathetic balance. These have the potential to guide analgesic management in patients where heightened sympathetic activity contributes significantly to nociception and where conventional indicators of nociception such as tachycardia and hypertension are present at baseline. This case report illustrates the integration of these technologies in managing a 16-year-old girl with L5-S1 grade 3 listhesis, chronic back pain, and heightened sympathetic activity having corrective spine surgery. .