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Background <p>Accurate nociception monitoring may optimize opioid administration during total knee arthroplasty. We aimed to evaluate whether the quantium nociception index (qNOX)-guided remifentanil infusion reduces opioid consumption and improves postoperative analgesia.</p> Methods <p>In this single-blind randomized trial, 84 patients undergoing total knee arthroplasty received either qNOX-guided (M group, <i>n</i> = 42) or conventional remifentanil infusion (R group, <i>n</i> = 42). Primary outcome was the incidence of Visual Analogue Scale (VAS) ≥ 5 within 40&#xa0;min postoperatively. Secondary outcomes included intraoperative remifentanil/propofol consumption, Quality of Recovery (QoR)-15 questionnaire, postoperative&#xa0;nausea&#xa0;and&#xa0;vomiting, hospital stay, and hemodynamic stability.</p> Results <p>M group demonstrated the following: Lower resting VAS ≥ 5 incidence (16.7% vs. 55.6%;&#xa0;relative risk [RR] 0.30, 95% CI 0.15 to 0.63; <i>P</i> = 0.023). The qNOX-guided strategy also led to a significant reduction in intraoperative remifentanil consumption (0.071 vs. 0.083&#xa0;µg·kg⁻<sup>1</sup>·min⁻<sup>1</sup>; <i>P</i> = 0.001) and a faster time to extubation (median 16 vs. 18&#xa0;min; <i>P</i> = 0.009). No differences were observed in propofol consumption, QoR-15 scores, or the incidence of postoperative nausea and vomiting.</p> Conclusion <p>qNOX-guided analgesia reduces intraoperative remifentanil requirements, accelerates recovery, and improves early postoperative pain control without increasing adverse events.</p> Trial registration <p>Chinese Clinical Trial Registry, ChiCTR2500107430. Registered August 11th, 2025, retrospectively registered.</p>

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Influence of qNOX-guided remifentanil titration on intraoperative dosing and postoperative pain in total knee arthroplasty: a pilot randomized trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月28日

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  • Fengrong Liu,
  • E. Wang,
  • Bei Huang,
  • Donglin Yang,
  • Xiaowei Gao

摘要

Background

Accurate nociception monitoring may optimize opioid administration during total knee arthroplasty. We aimed to evaluate whether the quantium nociception index (qNOX)-guided remifentanil infusion reduces opioid consumption and improves postoperative analgesia.

Methods

In this single-blind randomized trial, 84 patients undergoing total knee arthroplasty received either qNOX-guided (M group, n = 42) or conventional remifentanil infusion (R group, n = 42). Primary outcome was the incidence of Visual Analogue Scale (VAS) ≥ 5 within 40 min postoperatively. Secondary outcomes included intraoperative remifentanil/propofol consumption, Quality of Recovery (QoR)-15 questionnaire, postoperative nausea and vomiting, hospital stay, and hemodynamic stability.

Results

M group demonstrated the following: Lower resting VAS ≥ 5 incidence (16.7% vs. 55.6%; relative risk [RR] 0.30, 95% CI 0.15 to 0.63; P = 0.023). The qNOX-guided strategy also led to a significant reduction in intraoperative remifentanil consumption (0.071 vs. 0.083 µg·kg⁻1·min⁻1; P = 0.001) and a faster time to extubation (median 16 vs. 18 min; P = 0.009). No differences were observed in propofol consumption, QoR-15 scores, or the incidence of postoperative nausea and vomiting.

Conclusion

qNOX-guided analgesia reduces intraoperative remifentanil requirements, accelerates recovery, and improves early postoperative pain control without increasing adverse events.

Trial registration

Chinese Clinical Trial Registry, ChiCTR2500107430. Registered August 11th, 2025, retrospectively registered.