Influence of Intraoperative Pain Management on Postoperative Delirium in Elderly Patients: A Prospective Single-Center Randomized Controlled Trial.
Summary
In elderly TKA patients with sedation guided by BIS in both groups, NOX-guided intraoperative analgesia reduced day-1 postoperative delirium (7% vs 16%) and required higher remifentanil dosing. This supports nociception-index guidance as a modifiable intraoperative factor for delirium prevention.
Key Findings
- NOX-guided analgesia reduced day-1 postoperative delirium (7% vs 16%; P=0.041).
- Remifentanil dose was higher with NOX guidance (mean 927 vs 882 mg; P=0.002).
- Sedation depth was standardized with BIS in both groups, isolating the analgesia effect.
Clinical Implications
Incorporating nociception monitoring (e.g., NOX) to titrate intraoperative opioids while keeping sedation depth constant may reduce early postoperative delirium in older adults undergoing TKA.
Why It Matters
This RCT identifies intraoperative nociception-guided analgesia as a practical strategy to lower postoperative delirium, a major driver of morbidity in older surgical patients.
Limitations
- Single-center study may limit generalizability
- Delirium reduction demonstrated on postoperative day 1; longer-term cognitive outcomes not reported
Future Directions
Multicenter trials testing NOX-guided analgesia across procedures and exploring optimal opioid titration to balance pain control and delirium risk are warranted.
Study Information
- Study Type
- RCT
- Research Domain
- Prevention
- Evidence Level
- I - Randomized controlled trial providing high-level evidence of effect.
- Study Design
- OTHER