{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T02:36:27Z","timestamp":1769826987255,"version":"3.49.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,28]],"date-time":"2025-12-28T00:00:00Z","timestamp":1766880000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":33,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Natural Science key Foundation of Hunan Province","award":["2024JJ3051"],"award-info":[{"award-number":["2024JJ3051"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Anesth Analg Crit Care"],"DOI":"10.1186\/s44158-025-00330-2","type":"journal-article","created":{"date-parts":[[2025,12,28]],"date-time":"2025-12-28T05:54:21Z","timestamp":1766901261000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influence of qNOX-guided remifentanil titration on intraoperative dosing and postoperative pain in total knee arthroplasty: a pilot randomized trial"],"prefix":"10.1186","volume":"6","author":[{"given":"Fengrong","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bei","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donglin","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowei","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,28]]},"reference":[{"issue":"3","key":"330_CR1","doi-asserted-by":"publisher","first-page":"1333","DOI":"10.1007\/s00590-023-03798-2","volume":"34","author":"R Alrajeb","year":"2024","unstructured":"Alrajeb R, Zarti M, Shuia Z et al (2024) Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol 34(3):1333\u20131343. https:\/\/doi.org\/10.1007\/s00590-023-03798-2","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"6","key":"330_CR2","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-2827","volume":"53","author":"W Alrawashdeh","year":"2021","unstructured":"Alrawashdeh W, Eschweiler J, Migliorini F et al (2021) Effectiveness of total knee arthroplasty rehabilitation programmes: a systematic review and meta-analysis. J Rehabil Med 53(6):jrm00200. https:\/\/doi.org\/10.2340\/16501977-2827","journal-title":"J Rehabil Med"},{"issue":"3","key":"330_CR3","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1016\/j.arth.2022.10.011","volume":"38","author":"MJ DeFrance","year":"2023","unstructured":"DeFrance MJ, Scuderi GR (2023) Are 20% of patients actually dissatisfied following total knee arthroplasty? A systematic review of the literature. J Arthroplasty 38(3):594\u2013599. https:\/\/doi.org\/10.1016\/j.arth.2022.10.011","journal-title":"J Arthroplasty"},{"issue":"2","key":"330_CR4","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1038\/s41380-022-01815-0","volume":"28","author":"X Liu","year":"2023","unstructured":"Liu X, Bae C, Liu B et al (2023) Development of opioid-induced hyperalgesia depends on reactive astrocytes controlled by Wnt5a signaling. Mol Psychiatry 28(2):767\u2013779. https:\/\/doi.org\/10.1038\/s41380-022-01815-0","journal-title":"Mol Psychiatry"},{"key":"330_CR5","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.phrs.2017.02.012","volume":"120","author":"AA Weinbroum","year":"2017","unstructured":"Weinbroum AA (2017) Postoperative hyperalgesia-a clinically applicable narrative review. Pharmacol Res 120:188\u2013205. https:\/\/doi.org\/10.1016\/j.phrs.2017.02.012","journal-title":"Pharmacol Res"},{"issue":"9","key":"330_CR6","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1097\/eja.0000000000001691","volume":"39","author":"PM Lavand'homme","year":"2022","unstructured":"Lavand\u2019homme PM, Kehlet H, Rawal N et al (2022) Pain management after total knee arthroplasty: PROcedure SPEcific postoperative pain managemenT recommendations. Eur J Anaesthesiol 39(9):743\u2013757. https:\/\/doi.org\/10.1097\/eja.0000000000001691","journal-title":"Eur J Anaesthesiol"},{"issue":"4","key":"330_CR7","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1002\/ejp.1145","volume":"22","author":"F von Dincklage","year":"2018","unstructured":"von Dincklage F, Jakuscheit A, Weth J et al (2018) Higher doses of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption six months after total hip arthroplasty. Eur J Pain 22(4):691\u2013699. https:\/\/doi.org\/10.1002\/ejp.1145","journal-title":"Eur J Pain"},{"issue":"5","key":"330_CR8","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1213\/ane.0000000000002496","volume":"125","author":"LR Webster","year":"2017","unstructured":"Webster LR (2017) Risk factors for opioid-use disorder and overdose. Anesth Analg 125(5):1741\u20131748. https:\/\/doi.org\/10.1213\/ane.0000000000002496","journal-title":"Anesth Analg"},{"issue":"2","key":"330_CR9","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 (2019) Objective monitoring of nociception: a review of current commercial solutions. Br J Anaesth 123(2):e312\u2013e321. https:\/\/doi.org\/10.1016\/j.bja.2019.03.024","journal-title":"Br J Anaesth"},{"issue":"2","key":"330_CR10","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1016\/j.bja.2020.10.036","volume":"126","author":"PS Garc\u00eda","year":"2021","unstructured":"Garc\u00eda PS, Kreuzer M, Hight D et al (2021) Effects of noxious stimulation on the electroencephalogram during general anaesthesia: a narrative review and approach to analgesic titration. Br J Anaesth 126(2):445\u2013457. https:\/\/doi.org\/10.1016\/j.bja.2020.10.036","journal-title":"Br J Anaesth"},{"issue":"5","key":"330_CR11","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 et al (2019) Intraoperative monitoring of nociception for opioid administration: a meta-analysis of randomized controlled trials. Minerva Anestesiol 85(5):522\u2013530. https:\/\/doi.org\/10.23736\/s0375-9393.19.13151-3","journal-title":"Minerva Anestesiol"},{"issue":"6","key":"330_CR12","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1007\/s12630-021-01936-0","volume":"68","author":"V Sbeghen","year":"2021","unstructured":"Sbeghen V, Verdonck O, McDevitt J et al (2021) A randomized controlled trial comparing nociception level (NOL) index, blood pressure, and heart rate responses to direct laryngoscopy versus videolaryngoscopy for intubation: the NOLint project. Can J Anaesth 68(6):855\u2013867. https:\/\/doi.org\/10.1007\/s12630-021-01936-0","journal-title":"Can J Anaesth"},{"key":"330_CR13","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12154975","author":"C Chung","year":"2023","unstructured":"Chung C, Choi J, Lee T et al (2023) The effects of intraoperative remifentanil infusion on postoperative opioid consumption in patients who underwent total knee arthroplasty with femoral nerve block. J Clin Med. https:\/\/doi.org\/10.3390\/jcm12154975","journal-title":"J Clin Med"},{"key":"330_CR14","doi-asserted-by":"publisher","DOI":"10.3390\/medicina61020213","author":"\u015e Altuncu","year":"2025","unstructured":"Altuncu \u015e, Bollucuo\u011flu K, Okyay RD et al (2025) Analgesia nociception index monitoring in management of perioperative analgesia in total knee arthroplasty surgeries with femoral nerve block. Medicina (Kaunas). https:\/\/doi.org\/10.3390\/medicina61020213","journal-title":"Medicina (Kaunas)"},{"issue":"3","key":"330_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2022.101081","volume":"41","author":"E Renaud-Roy","year":"2022","unstructured":"Renaud-Roy E, Morisson L, Brulotte V et al (2022) Effect of combined intraoperative use of the nociception level (NOL) and bispectral (BIS) indexes on desflurane administration. Anaesth Crit Care Pain Med 41(3):101081. https:\/\/doi.org\/10.1016\/j.accpm.2022.101081","journal-title":"Anaesth Crit Care Pain Med"},{"issue":"3","key":"330_CR16","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1016\/j.bja.2024.10.051","volume":"134","author":"H Kong","year":"2025","unstructured":"Kong H, Ma DD, Ma JH et al (2025) Qnox index for quantification of intraoperative nociception and analgesia: a prospective single-centre validation study. Br J Anaesth 134(3):736\u2013745. https:\/\/doi.org\/10.1016\/j.bja.2024.10.051","journal-title":"Br J Anaesth"},{"issue":"2","key":"330_CR17","doi-asserted-by":"publisher","first-page":"264","DOI":"10.4103\/joacp.joacp_453_22","volume":"40","author":"M Praveen","year":"2024","unstructured":"Praveen M, Kumar A, Parikh B et al (2024) Evaluation of qCON and qNOX indices in pediatric surgery under general anesthesia. J Anaesthesiol Clin Pharmacol 40(2):264\u2013270. https:\/\/doi.org\/10.4103\/joacp.joacp_453_22","journal-title":"J Anaesthesiol Clin Pharmacol"},{"issue":"1","key":"330_CR18","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.bja.2017.11.013","volume":"120","author":"J Kleif","year":"2018","unstructured":"Kleif J, Waage J, Christensen KB et al (2018) Systematic review of the QoR-15 score, a patient- reported outcome measure measuring quality of recovery after surgery and anaesthesia. Br J Anaesth 120(1):28\u201336. https:\/\/doi.org\/10.1016\/j.bja.2017.11.013","journal-title":"Br J Anaesth"},{"issue":"1","key":"330_CR19","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 et al (2016) Preliminary intraoperative validation of the Nociception Level Index: a noninvasive nociception monitor. Anesthesiology 125(1):193\u2013203. https:\/\/doi.org\/10.1097\/aln.0000000000001130","journal-title":"Anesthesiology"},{"issue":"1","key":"330_CR20","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1007\/s10877-022-00897-z","volume":"37","author":"L Morisson","year":"2023","unstructured":"Morisson L, Nadeau-Vall\u00e9e M, Espitalier F et al (2023) Prediction of acute postoperative pain based on intraoperative nociception level (NOL) index values: the impact of machine learning-based analysis. J Clin Monit Comput 37(1):337\u2013344. https:\/\/doi.org\/10.1007\/s10877-022-00897-z","journal-title":"J Clin Monit Comput"},{"key":"330_CR21","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.963185","volume":"9","author":"D Ma","year":"2022","unstructured":"Ma D, Ma J, Chen H et al (2022) Nociception monitors vs. standard practice for titration of opioid administration in general anesthesia: a meta-analysis of randomized controlled trials. Front Med 9:963185. https:\/\/doi.org\/10.3389\/fmed.2022.963185","journal-title":"Front Med"},{"key":"330_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2021.110497","volume":"75","author":"F Espitalier","year":"2021","unstructured":"Espitalier F, Idrissi M, Fortier A et al (2021) Impact of Nociception Level (NOL) index intraoperative guidance of fentanyl administration on opioid consumption, postoperative pain scores and recovery in patients undergoing gynecological laparoscopic surgery. A randomized controlled trial. J Clin Anesth 75:110497. https:\/\/doi.org\/10.1016\/j.jclinane.2021.110497","journal-title":"J Clin Anesth"},{"key":"330_CR23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2024.111659","volume":"99","author":"L Morisson","year":"2024","unstructured":"Morisson L, Harkouk H, Othenin-Girard A et al (2024) Impact of deep neuromuscular blockade on intraoperative NOL-guided remifentanil requirement during desflurane anesthesia in laparoscopic colorectal surgeries: a randomised controlled trial. J Clin Anesth 99:111659. https:\/\/doi.org\/10.1016\/j.jclinane.2024.111659","journal-title":"J Clin Anesth"},{"issue":"12","key":"330_CR24","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 et al (2023) Effect of nociception level index-guided intra-operative analgesia on early postoperative pain and opioid consumption: a systematic review and meta-analysis. Anaesthesia 78(12):1493\u20131501. https:\/\/doi.org\/10.1111\/anae.16148","journal-title":"Anaesthesia"},{"issue":"6","key":"330_CR25","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1093\/ndt\/gfz129","volume":"35","author":"CE Buchanan","year":"2020","unstructured":"Buchanan CE, Mahmoud H, Cox EF et al (2020) Quantitative assessment of renal structural and functional changes in chronic kidney disease using multi-parametric magnetic resonance imaging. Nephrol Dial Transplant 35(6):955\u2013964. https:\/\/doi.org\/10.1093\/ndt\/gfz129","journal-title":"Nephrol Dial Transplant"},{"key":"330_CR26","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.951881","volume":"9","author":"Z Song","year":"2022","unstructured":"Song Z, Yang Z, Hou M et al (2022) Machine learning in predicting cardiac surgery-associated acute kidney injury: a systemic review and meta-analysis. Front Cardiovasc Med 9:951881. https:\/\/doi.org\/10.3389\/fcvm.2022.951881","journal-title":"Front Cardiovasc Med"},{"issue":"6","key":"330_CR27","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1097\/mcc.0000000000001213","volume":"30","author":"D De Backer","year":"2024","unstructured":"De Backer D, Rimachi R, Duranteau J (2024) Hemodynamic management of acute kidney injury. Curr Opin Crit Care 30(6):542\u2013547. https:\/\/doi.org\/10.1097\/mcc.0000000000001213","journal-title":"Curr Opin Crit Care"},{"issue":"3","key":"330_CR28","doi-asserted-by":"publisher","first-page":"e62","DOI":"10.1097\/mjt.0000000000000019","volume":"22","author":"SH Kim","year":"2015","unstructured":"Kim SH, Stoicea N, Soghomonyan S et al (2015) Remifentanil-acute opioid tolerance and opioid-induced hyperalgesia: a systematic review. Am J Ther 22(3):e62-74. https:\/\/doi.org\/10.1097\/mjt.0000000000000019","journal-title":"Am J Ther"},{"issue":"11","key":"330_CR29","doi-asserted-by":"publisher","first-page":"1347","DOI":"10.1111\/anae.13602","volume":"71","author":"EH Yu","year":"2016","unstructured":"Yu EH, Tran DH, Lam SW et al (2016) Remifentanil tolerance and hyperalgesia: short-term gain, long-term pain? Anaesthesia 71(11):1347\u20131362. https:\/\/doi.org\/10.1111\/anae.13602","journal-title":"Anaesthesia"},{"issue":"12","key":"330_CR30","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0209078","volume":"13","author":"HC Lee","year":"2018","unstructured":"Lee HC, Ryu HG, Kim HJ et al (2018) Excessive remifentanil during total intravenous anesthesia is associated with increased risk of pain after robotic thyroid surgery. PLoS One 13(12):e0209078. https:\/\/doi.org\/10.1371\/journal.pone.0209078","journal-title":"PLoS One"},{"issue":"1","key":"330_CR31","doi-asserted-by":"publisher","DOI":"10.1186\/s44158-025-00245-y","volume":"5","author":"V Torrano","year":"2025","unstructured":"Torrano V, Anastasi S, Balzani E et al (2025) Enhancing safety in regional anesthesia: guidelines from the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI). J Anesth Analg Crit Care 5(1):26. https:\/\/doi.org\/10.1186\/s44158-025-00245-y","journal-title":"J Anesth Analg Crit Care"}],"container-title":["Journal of Anesthesia, Analgesia and Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44158-025-00330-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44158-025-00330-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44158-025-00330-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T13:53:08Z","timestamp":1769781188000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s44158-025-00330-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,28]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["330"],"URL":"https:\/\/doi.org\/10.1186\/s44158-025-00330-2","relation":{},"ISSN":["2731-3786"],"issn-type":[{"value":"2731-3786","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,28]]},"assertion":[{"value":"26 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol was reviewed and approved by the Ethics Committee of the Second Xiangya Hospital of Central South University (initial approval No.: LYEC2024-0397; renewed under annual review No.: LYEC2025-K0027). Both approval numbers refer to the same protocol.Written informed consent was obtained from all participants prior to enrollment, in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable. This manuscript does not contain any individual person\u2019s data in any form.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"13"}}