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Summary: Acute postoperative pain remains a critical treatment priority and has prompted a search for technologies and techniques to assist with intra‐operative analgesic monitoring and management. Anaesthetists traditionally rely on clinical judgement to guide intra‐operative analgesia, but several emerging technologies such as the nociception level index herald the possibility of routine intra‐operative analgesia monitoring. However, the impact of devices like nociception level index on postoperative outcomes has not been proven. We undertook a systematic review and meta‐analysis of articles which compared nociception level index‐guided analgesia to standard care. The primary outcomes were pain intensity and opioid consumption during the first 60–120 min after surgery. Secondary outcomes were the incidence of postoperative nausea and vomiting and duration of stay in the post‐anaesthesia care unit. Ten studies, collectively including 662 patients and published between 2019 and 2023, met inclusion criteria for both the qualitative systematic review and quantitative meta‐analysis. Risk of methodological bias was generally low or unclear, and six studies reported a significant conflict of interest relevant to their findings. Our meta‐analysis was performed using a random‐effects model. It found statistically significant benefits of nociception level index‐guided analgesia for early postoperative pain (mean (95%CI) difference ‐0.46 (‐0.88 to ‐0.03) on an 11‐point scale, p = 0.03), and opioid requirement (mean (95%CI) difference ‐1.04 (‐1.94 to ‐0.15) mg intravenous morphine equivalent, p = 0.02). Our meta‐analysis of the current literature finds that nociception level index‐guided analgesia statistically significantly reduces reported postoperative pain intensity and opioid consumption but fails to show clinically relevant outcomes. We found no evidence that nociception level index‐guided analgesia affected postoperative nausea and vomiting nor duration of stay in the post‐anaesthesia care unit. [ABSTRACT FROM AUTHOR]

The article discusses the use of nociception level-guided anesthesia and its effect on pain levels and opioid consumption in the post-anesthesia care unit. The authors conducted a meta-analysis and found that while there are studies suggesting that this type of anesthesia may reduce postoperative pain, the evidence is not strong enough to recommend its general use. They support the call for further research, particularly in vulnerable patient groups and procedures associated with severe postoperative pain. The article concludes that more investigation is needed to fully understand the potential benefits and limitations of nociception level-guided anesthesia. [Extracted from the article]