{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T20:30:23Z","timestamp":1789504223611,"version":"build-2803163510"},"reference-count":82,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Autonomic nervous system\u2013based nociception monitors have been proposed to optimise intraoperative opioid administration. While they reduce intraoperative opioid use, evidence on postoperative outcomes remains limited. We conducted a systematic review and meta\u2010analysis to evaluate their effects on postoperative pain, opioid consumption and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      MEDLINE, EMBASE, LILACS, Google Scholar, Cochrane and\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      were searched for randomised controlled trials comparing intraoperative nociception monitoring with standard care and reporting postoperative outcomes. Risk of bias was assessed per Cochrane guidance. Data were pooled with random\u2010effects models (RevMan 5.4.1). Continuous outcomes were summarised as mean or standardised mean differences (95% CI) and dichotomous outcomes as risk ratios (95% CI).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty\u2010eight RCTs comprising 3243 patients were included. Post\u2010anaesthesia care unit (PACU) opioid consumption was lower in monitor\u2010guided groups (mean difference \u22120.6\u2009mg, 95% CI \u20131.00 to \u22120.19). Likewise, 24\u2010h morphine consumption decreased (mean difference \u22122.56\u2009mg, 95% CI \u20134.01 to \u22121.11); however, these reductions did not reach the minimal clinically important difference. PACU and 24\u2010h pain scores, as well as the incidence of postoperative nausea and vomiting, respiratory events, urinary retention, delirium and chronic postsurgical pain (CPSP), were not significantly different between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intraoperative nociception monitors modestly reduce early postoperative opioid requirements, but without clinically meaningful benefit. No improvements were observed in postoperative pain or complications. These findings suggest that, despite their impact on intraoperative opioid titration, nociception monitors do not improve patient\u2010centered postoperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>This systematic review and meta\u2010analysis shows that intraoperative autonomic nervous system\u2010based nociception monitors significantly reduce postoperative opioid consumption at PACU discharge and 24 hours, but the effect size does not reach the minimal clinically important difference. Pain scores and postoperative complications are not significantly impacted. These findings suggest that, while nociception monitors influence intraoperative opioid titration, their clinical benefit on postoperative outcomes remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      PROSPERO number: CRD42023490440; ClinicalTrials.gov identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42023490440\">https:\/\/www.crd.york.ac.uk\/prospero\/display_record.php?ID=CRD42023490440<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70227","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T13:54:28Z","timestamp":1770126868000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Systematic Review and Meta\u2010Analysis of Postoperative Opioid Consumption, Pain and Complications Following Intraoperative Autonomic Nervous System\u2010Based Nociception Monitoring"],"prefix":"10.1002","volume":"30","author":[{"given":"Mathias A. 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