The role of intraoperative real-time nociceptive monitoring in individualised anaesthesia and analgesia and where to head next; A narrative review
Authors' conclusion
Current real-time nociception monitors should be considered adjuncts rather than standalone tools.
Study context
- Population
- Literature on real-time intraoperative nociception monitoring devices (Analgesia Nociception Index, Surgical Pleth Index, Nociception Level Index, pupillometry, skin conductance, processed EEG, Quantum Nociception Index)
Methodological detailsqualitative evaluation
- Qualitative evaluation
Main finding
As reported in the abstract
- All monitors based on physiologically plausible surrogates of nociception, primarily autonomic or neurophysiologic responses
- Devices can influence intraoperative opioid titration, but predictive accuracy for postoperative pain is modest and inconsistent
- Confounders (anaesthetic depth, vasoactive drugs, patient variability) limit specificity
- Pooled data and RCTs show small or no clinically meaningful improvements in postoperative outcomes
- Multimodal approaches and integration with anaesthesia depth monitoring may enhance utility; robust, procedure-specific protocols lacking
Original publication
The role of intraoperative real-time nociceptive monitoring in individualised anaesthesia and analgesia and where to head next; A narrative review. J Clin Anesth. Published 21 February 2026. doi:10.
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