{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T08:10:04Z","timestamp":1789027804018,"version":"build-2803163510"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Clin Monit Comput"],"DOI":"10.1007\/s10877-026-01459-3","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T08:03:20Z","timestamp":1782115400000},"page":"1011-1023","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nociception-guided opioid administration within multimodal analgesia for laparoscopic endometriosis surgery: a randomized controlled trial"],"prefix":"10.1007","volume":"40","author":[{"given":"Hoang-Thi","family":"Buis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Berger-Estilita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Zirngast","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Ranner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tihomir","family":"Piskor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Marcolino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"1459_CR1","doi-asserted-by":"publisher","first-page":"2287","DOI":"10.2147\/JPR.S144066","volume":"10","author":"TJ Gan","year":"2017","unstructured":"Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287\u201398. https:\/\/doi.org\/10.2147\/JPR.S144066.","journal-title":"J Pain Res"},{"issue":"1","key":"1459_CR2","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.atc.2004.11.013","volume":"23","author":"GP Joshi","year":"2005","unstructured":"Joshi GP, Ogunnaike BO. Consequences of Inadequate Postoperative Pain Relief and Chronic Persistent Postoperative Pain. Anesthesiol Clin N Am. 2005;23(1):21\u201336. https:\/\/doi.org\/10.1016\/j.atc.2004.11.013.","journal-title":"Anesthesiol Clin N Am"},{"issue":"9522","key":"1459_CR3","doi-asserted-by":"publisher","first-page":"1618","DOI":"10.1016\/S0140-6736(06)68700-X","volume":"367","author":"H Kehlet","year":"2006","unstructured":"Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. The Lancet. 2006;367(9522):1618\u201325. https:\/\/doi.org\/10.1016\/S0140-6736(06)68700-X.","journal-title":"The Lancet"},{"key":"1459_CR4","unstructured":"Butterworth JF. Morgan & Mikhail\u2019s Clinical Anesthesiology. seventh edition. New York: McGraw-Hill LLC; 2022. 1 p. (McGraw-Hill\u2019s AccessMedicine)."},{"issue":"5","key":"1459_CR5","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/S1526-5900(03)00556-X","volume":"4","author":"E McNicol","year":"2003","unstructured":"McNicol E, Horowicz-Mehler N, Fisk RA, Bennett K, Gialeli-Goudas M, Chew PW, et al. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003;4(5):231\u201356. https:\/\/doi.org\/10.1016\/S1526-5900(03)00556-X.","journal-title":"J Pain"},{"issue":"5","key":"1459_CR6","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1111\/anae.14582","volume":"74","author":"J Frauenknecht","year":"2019","unstructured":"Frauenknecht J, Kirkham KR, Jacot\u2010Guillarmod A, Albrecht E. Analgesic impact of intra\u2010operative opioids vs. opioid\u2010free anaesthesia: a systematic review and meta\u2010analysis. Anaesthesia. 2019;74(5):651\u201362. https:\/\/doi.org\/10.1111\/anae.14582.","journal-title":"Anaesthesia"},{"issue":"4","key":"1459_CR7","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1056\/NEJMsr1706626","volume":"377","author":"ND Volkow","year":"2017","unstructured":"Volkow ND, Collins FS. The Role of Science in Addressing the Opioid Crisis. N Engl J Med. 2017;377(4):391\u20134. https:\/\/doi.org\/10.1056\/NEJMsr1706626.","journal-title":"N Engl J Med"},{"issue":"12","key":"1459_CR8","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.1111\/anae.16148","volume":"78","author":"H Bornemann-Cimenti","year":"2023","unstructured":"Bornemann-Cimenti H, Lang-Illievich K, Kovalevska K, Brenna CTA, Klivinyi C. Effect of nociception level index-guided intra-operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta-analysis. Anaesthesia. 2023;78(12):1493\u2013501. https:\/\/doi.org\/10.1111\/anae.16148.","journal-title":"Anaesthesia"},{"issue":"4","key":"1459_CR9","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1046\/j.1365-2702.2001.00492.x","volume":"10","author":"MW Stomberg","year":"2001","unstructured":"Stomberg MW, Sj\u00f6str\u00f6m B, Haljam\u00e4e H. Routine intra-operative assessment of pain and\/or depth of anaesthesia by nurse anaesthetists in clinical practice. J Clin Nurs. 2001;10(4):429\u201336.","journal-title":"J Clin Nurs"},{"issue":"2","key":"1459_CR10","doi-asserted-by":"publisher","first-page":"e312","DOI":"10.1016\/j.bja.2019.03.024","volume":"123","author":"T Ledowski","year":"2019","unstructured":"Ledowski T. Objective monitoring of nociception: a review of current commercial solutions. Br J Anaesth. 2019;123(2):e312\u201321. https:\/\/doi.org\/10.1016\/j.bja.2019.03.024.","journal-title":"Br J Anaesth"},{"issue":"1","key":"1459_CR11","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1097\/ALN.0000000000001130","volume":"125","author":"R Edry","year":"2016","unstructured":"Edry R, Recea V, Dikust Y, Sessler DI. Preliminary Intraoperative Validation of the Nociception Level Index: A Noninvasive Nociception Monitor. Anesthesiology. 2016;125(1):193\u2013203. https:\/\/doi.org\/10.1097\/ALN.0000000000001130.","journal-title":"Anesthesiology"},{"issue":"3","key":"1459_CR12","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1097\/ALN.0000000000000757","volume":"123","author":"CH Martini","year":"2015","unstructured":"Martini CH, Boon M, Broens SJL, Hekkelman EF, Oudhoff LA, Buddeke AW, et al. Ability of the Nociception Level, a Multiparameter Composite of Autonomic Signals, to Detect Noxious Stimuli during Propofol-Remifentanil Anesthesia. Anesthesiology. 2015;123(3):524\u201334. https:\/\/doi.org\/10.1097\/ALN.0000000000000757.","journal-title":"Anesthesiology"},{"issue":"5","key":"1459_CR13","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1213\/ANE.0000000000007180","volume":"139","author":"MS Sogut","year":"2024","unstructured":"Sogut MS, Kalyoncu I, Karakaya MA, Manici M, Dar\u00e7in K. Does Nociception Level Index-Guided opioid administration reduce intraoperative opioid consumption? A systematic review and meta-analysis. Anesth Analg. 2024;139(5):978\u201385. https:\/\/doi.org\/10.1213\/ANE.0000000000007180.","journal-title":"Anesth Analg"},{"key":"1459_CR14","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.963185","volume":"9","author":"D Ma","year":"2022","unstructured":"Ma D, Ma J, Chen H, Mu D, Kong H, Yu L. Nociception monitors vs. standard practice for titration of opioid administration in general anesthesia: A meta-analysis of randomized controlled trials. Front Med. 2022;9:963185. https:\/\/doi.org\/10.3389\/fmed.2022.963185.","journal-title":"Front Med"},{"issue":"2","key":"1459_CR15","first-page":"46","volume":"33","author":"V Graff","year":"2018","unstructured":"Graff V, Grosh T. Multimodal Analgesia and Alternatives to Opioids for Postoperative Analgesia. Anesth Patient Saf Found. 2018;33(2):46\u20137.","journal-title":"Anesth Patient Saf Found"},{"issue":"9784","key":"1459_CR16","doi-asserted-by":"publisher","first-page":"2215","DOI":"10.1016\/S0140-6736(11)60245-6","volume":"377","author":"CL Wu","year":"2011","unstructured":"Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet Lond Engl. 2011;377(9784):2215\u201325. https:\/\/doi.org\/10.1016\/S0140-6736(11)60245-6. (PubMed PMID: 21704871).","journal-title":"Lancet Lond Engl"},{"issue":"2","key":"1459_CR17","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1213\/ANE.0000000000004018","volume":"129","author":"DA Edwards","year":"2019","unstructured":"Edwards DA, Hedrick TL, Jayaram J, Argoff C, Gulur P, Holubar SD, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Management of Patients on Preoperative Opioid Therapy. Anesth Analg. 2019;129(2):553\u201366. https:\/\/doi.org\/10.1213\/ANE.0000000000004018. (PubMed PMID: 30768461).","journal-title":"Anesth Analg"},{"issue":"7","key":"1459_CR18","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1001\/jamasurg.2017.0898","volume":"152","author":"EC Wick","year":"2017","unstructured":"Wick EC, Grant MC, Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques: A Review. JAMA Surg. 2017;152(7):691\u20137. https:\/\/doi.org\/10.1001\/jamasurg.2017.0898.","journal-title":"JAMA Surg"},{"issue":"2","key":"1459_CR19","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1016\/j.fertnstert.2011.05.090","volume":"96","author":"KE Nnoaham","year":"2011","unstructured":"Nnoaham KE, Hummelshoj L, Webster P, D\u2019Hooghe T, De Cicco NF, De Cicco NC, et al. Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril. 2011;96(2):366-373.e8. https:\/\/doi.org\/10.1016\/j.fertnstert.2011.05.090.","journal-title":"Fertil Steril"},{"issue":"14","key":"1459_CR20","doi-asserted-by":"publisher","DOI":"10.3389\/fncel.2020.590823","volume":"6","author":"J Maddern","year":"2020","unstructured":"Maddern J, Grundy L, Castro J, Brierley SM. Pain in Endometriosis Front Cell Neurosci. 2020;6(14):590823. https:\/\/doi.org\/10.3389\/fncel.2020.590823.","journal-title":"Pain in Endometriosis Front Cell Neurosci"},{"issue":"1","key":"1459_CR21","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s40360-017-0149-2","volume":"18","author":"PJ Samuelsen","year":"2017","unstructured":"Samuelsen PJ, Nielsen CS, Wilsgaard T, Stubhaug A, Svendsen K, Eggen AE. Pain sensitivity and analgesic use among 10,486 adults: the Troms\u00f8 study. BMC Pharmacol Toxicol. 2017;18(1):45. https:\/\/doi.org\/10.1186\/s40360-017-0149-2.","journal-title":"BMC Pharmacol Toxicol"},{"issue":"2","key":"1459_CR22","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1007\/s43032-024-01763-w","volume":"32","author":"GE Cetera","year":"2025","unstructured":"Cetera GE, Merli CEM, Vercellini P. A Multimodal Approach to Symptomatic Endometriosis: A Proposed Algorithm for Clinical Management. Reprod Sci Thousand Oaks Calif. 2025;32(2):289\u201399. https:\/\/doi.org\/10.1007\/s43032-024-01763-w. (PubMed PMID: 39775786).","journal-title":"Reprod Sci Thousand Oaks Calif"},{"issue":"1","key":"1459_CR23","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1001\/jama.2025.2975","volume":"334","author":"S As-Sanie","year":"2025","unstructured":"As-Sanie S, Mackenzie SC, Morrison L, Schrepf A, Zondervan KT, Horne AW, et al. Endometriosis: A Review. JAMA. 2025;334(1):64\u201378. https:\/\/doi.org\/10.1001\/jama.2025.2975.","journal-title":"JAMA"},{"key":"1459_CR24","unstructured":"World Medical Association. WMA Declaration of Helsinki \u2013 Ethical Principles for Medical Research Involving Human Participants. In: 75th WMA General Assembly. Helsinki: World Medical Association; 2024."},{"key":"1459_CR25","unstructured":"European Medicines Agency. ICH E6 Good clinical practice - Scientific guideline [Scientific guideline]. London: European Medicines Agency (EMA); 2016. Scientific guideline EMA\/CHMP\/ICH\/135\/1995."},{"issue":"mar23 1","key":"1459_CR26","doi-asserted-by":"publisher","first-page":"c332","DOI":"10.1136\/bmj.c332","volume":"340","author":"KF Schulz","year":"2010","unstructured":"Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340(mar23 1):c332\u2013c332. https:\/\/doi.org\/10.1136\/bmj.c332.","journal-title":"BMJ"},{"issue":"4","key":"1459_CR27","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1007\/s10877-020-00540-9","volume":"35","author":"JP van den Berg","year":"2021","unstructured":"van den Berg JP, Absalom AR, Venema AM, Kalmar AF, Van Amsterdam K, Hannivoort LN, et al. Comparison of haemodynamic- and electroencephalographic-monitored effects evoked by four combinations of effect-site concentrations of propofol and remifentanil, yielding a predicted tolerance to laryngoscopy of 90%. J Clin Monit Comput. 2021;35(4):815\u201325. https:\/\/doi.org\/10.1007\/s10877-020-00540-9.","journal-title":"J Clin Monit Comput"},{"issue":"13","key":"1459_CR28","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.2165\/00003495-200565130-00007","volume":"65","author":"LJ Scott","year":"2005","unstructured":"Scott LJ, Perry CM. Remifentanil: a review of its use during the induction and maintenance of general anaesthesia. Drugs. 2005;65(13):1793\u2013823. https:\/\/doi.org\/10.2165\/00003495-200565130-00007. (PubMed PMID: 16114980).","journal-title":"Drugs"},{"issue":"15","key":"1459_CR29","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.2165\/00023210-200418150-00004","volume":"18","author":"R Beers","year":"2004","unstructured":"Beers R, Camporesi E. Remifentanil update: clinical science and utility. CNS Drugs. 2004;18(15):1085\u2013104. https:\/\/doi.org\/10.2165\/00023210-200418150-00004. (PubMed PMID: 15581380).","journal-title":"CNS Drugs"},{"issue":"2","key":"1459_CR30","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1097\/00000542-200008000-00019","volume":"93","author":"B Guignard","year":"2000","unstructured":"Guignard B, Bossard AE, Coste C, Sessler DI, Lebrault C, Alfonsi P, et al. Acute Opioid Tolerance: Intraoperative Remifentanil Increases Postoperative Pain and Morphine Requirement. Anesthesiology. 2000;93(2):409. https:\/\/doi.org\/10.1097\/00000542-200008000-00019.","journal-title":"Anesthesiology"},{"issue":"10180","key":"1459_CR31","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1016\/S0140-6736(19)30430-1","volume":"393","author":"LA Colvin","year":"2019","unstructured":"Colvin LA, Bull F, Hales TG. Perioperative opioid analgesia\u2014when is enough too much? A review of opioid-induced tolerance and hyperalgesia. The Lancet. 2019;393(10180):1558\u201368. https:\/\/doi.org\/10.1016\/S0140-6736(19)30430-1.","journal-title":"The Lancet"},{"key":"1459_CR32","unstructured":"Simple randomisation service | Sealed Envelope. 2026. Available from: https:\/\/www.sealedenvelope.com\/simple-randomiser\/v1\/"},{"issue":"6","key":"1459_CR33","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1002\/pds.3945","volume":"25","author":"S Nielsen","year":"2016","unstructured":"Nielsen S, Degenhardt L, Hoban B, Gisev N. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf. 2016;25(6):733\u20137. https:\/\/doi.org\/10.1002\/pds.3945. (PubMed PMID: 26693665).","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"5","key":"1459_CR34","doi-asserted-by":"publisher","first-page":"522","DOI":"10.23736\/S0375-9393.19.13151-3","volume":"85","author":"Y Jiao","year":"2019","unstructured":"Jiao Y, He B, Tong X, Xia R, Zhang C, Shi X. Intraoperative monitoring of nociception for opioid administration: a meta-analysis of randomized controlled trials. Minerva Anestesiol. 2019;85(5):522\u201330. https:\/\/doi.org\/10.23736\/S0375-9393.19.13151-3. (PubMed PMID: 30735017).","journal-title":"Minerva Anestesiol"},{"issue":"1","key":"1459_CR35","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.bja.2024.09.020","volume":"134","author":"MAJ Snoek","year":"2025","unstructured":"Snoek MAJ, van den Berg VJ, Dahan A, Boon M. Comparison of different monitors for measurement of nociception during general anaesthesia: a network meta-analysis of randomised controlled trials. Br J Anaesth. 2025;134(1):180\u201391. https:\/\/doi.org\/10.1016\/j.bja.2024.09.020. (PubMed PMID: 39609176).","journal-title":"Br J Anaesth"},{"issue":"5","key":"1459_CR36","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1213\/ANE.0000000000003668","volume":"127","author":"EN Brown","year":"2018","unstructured":"Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia: Theory and Practice. Anesth Analg. 2018;127(5):1246\u201358. https:\/\/doi.org\/10.1213\/ANE.0000000000003668. (PubMed PMID: 30252709; PubMed Central PMCID: PMC6203428).","journal-title":"Anesth Analg"},{"issue":"2","key":"1459_CR37","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1213\/ane.0b013e31817b859e","volume":"107","author":"JFA Hendrickx","year":"2008","unstructured":"Hendrickx JFA, Eger EII, Sonner JM, Shafer SL. Is Synergy the Rule? A Review of Anesthetic Interactions Producing Hypnosis and Immobility. Anesth Analg. 2008;107(2):494. https:\/\/doi.org\/10.1213\/ane.0b013e31817b859e.","journal-title":"Anesth Analg"},{"issue":"4","key":"1459_CR38","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1111\/1471-0528.18021","volume":"132","author":"FS Kanti","year":"2025","unstructured":"Kanti FS, Allard V, M\u00e9tivier AA, Lemyre M, Arendas K, Maheux-Lacroix S. Pain Phenotypes in Endometriosis: A Population-Based Study Using Latent Class Analysis. BJOG Int J Obstet Gynaecol. 2025;132(4):492\u2013503. https:\/\/doi.org\/10.1111\/1471-0528.18021. (PubMedPMID:39627905;PubMedCentralPMCID:PMC11794060).","journal-title":"BJOG Int J Obstet Gynaecol"},{"key":"1459_CR39","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1056\/NEJMra1810764","volume":"382","author":"SKT Zondervan","year":"2020","unstructured":"Zondervan SKT. Endometriosis. N Engl J Med. 2020;382:1244\u201356.","journal-title":"N Engl J Med"}],"container-title":["Journal of Clinical Monitoring and Computing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10877-026-01459-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10877-026-01459-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10877-026-01459-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T07:58:55Z","timestamp":1789027135000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10877-026-01459-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,22]]},"references-count":39,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["1459"],"URL":"https:\/\/doi.org\/10.1007\/s10877-026-01459-3","relation":{},"ISSN":["1573-2614"],"issn-type":[{"value":"1573-2614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,22]]},"assertion":[{"value":"3 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study did not involve animal subjects.","order":1,"name":"Ethics","label":"Animal research","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"JBE has received speaker\u2019s fees from Medtronic (paid to institution) and is a board member of the European Society of Anaesthesiology and Intensive Care. All authors declare that they have no financial or personal relationships that could be perceived as potential conflicts of interest related to this work. No external commercial funding was received for this study. Institutional resources were used exclusively to support study conduct.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This clinical trial was prospectively registered prior to patient enrollment at ClinicalTrials.gov (Identifier: NCT06732050). The methods and outcomes reported in this manuscript are consistent with the registered protocol.","order":3,"name":"Ethics","label":"Clinical trial registration","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and complied with Good Clinical Practice guidelines. The study protocol was reviewed and approved by the Ethics Committee of the Canton of Zurich (BASEC No. 2024\u201300822). Written informed consent was obtained from all participants prior to inclusion. Participant confidentiality was strictly maintained, and all data were de-identified prior to analysis.","order":4,"name":"Ethics","label":"Ethical approval and protection of human subjects","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors affirm adherence to ethical research conduct and scientific integrity. No fabrication, falsification, inappropriate authorship designation, or other forms of scientific misconduct occurred. The authors agree to cooperate fully with the Journal should any questions arise regarding ethical or scientific aspects of the work.","order":5,"name":"Ethics","label":"Ethical and scientific integrity","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All medications administered in this study were used in accordance with established clinical practice and within accepted dosing ranges. No investigational drugs, neuraxial or perineural investigational drug administration, or pediatric drug use outside standard clinical indications were involved.","order":6,"name":"Ethics","label":"Investigational drugs","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This manuscript represents original work that has not been published previously and is not under consideration for publication elsewhere. Preliminary data from this study were presented as a poster at Euroanaesthesia 2025 (Lisbon, Portugal). The authors affirm compliance with journal policies on plagiarism and duplicate publication.","order":7,"name":"Ethics","label":"Plagiarism and duplicate publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Generative artificial intelligence tools were not used to generate study data, results, or references. We used AI-assisted support (ChatGPT V5.2) during manuscript preparation, which was limited to language refinement and did not replace the authors\u2019 intellectual contributions. Responsibility for the content of the manuscript rests entirely with the authors.","order":8,"name":"Ethics","label":"Use of generative artificial intelligence","group":{"name":"EthicsHeading","label":"Declarations"}}]}}