Oliceridine vs Sufentanil in Gynecologic Laparoscopic Surgery

Key Takeaways

• Lower 48-hour PONV was observed with oliceridine, and the between-group difference remained significant after adjustment.
• Pain scores, rescue analgesic use, and length of stay were similar, while QoR-15 and satisfaction were higher with oliceridine.

Among women undergoing gynecologic laparoscopic surgery, a randomized trial found less 48-hour postoperative nausea and vomiting with oliceridine than with sufentanil. The primary outcome was PONV within 48 hours after surgery. Crude event rates were 22.5% with oliceridine and 43.0% with sufentanil.

The randomized comparison followed patients for 48 hours after surgery. For the primary endpoint, the odds ratio for PONV was 0.38, with a 95% confidence interval of 0.22 to 0.66 and P less than 0.001. The association remained significant after adjustment in Model 1, with an odds ratio of 0.37, and in Model 2, with an odds ratio of 0.36. The absolute risk reduction was 20.5%, the relative risk was 0.52, and the reported number needed to treat was 5.

PONV severity also differed between groups over 48 hours. Severe PONV was less frequent with oliceridine at 3.9% versus 15.6%, while moderate PONV trended lower at 7.0% versus 16.4% but did not meet the significance threshold after correction for multiple comparisons, and mild PONV was similar at 11.6% versus 10.9%. Most prespecified subgroups favored oliceridine, and type of surgery showed a significant interaction, with P for interaction of 0.047. Rates were 15.4% versus 50.0% for ovarian cystectomy or tubal surgery, 23.7% versus 50.0% for total hysterectomy, 25.0% versus 43.8% for myomectomy, and 30.0% versus 15.0% for malignant surgery.

Analgesic outcomes were broadly similar between groups. Median maximum NRS pain score was 4 versus 3, the proportion with NRS pain score at least 4 was 51.2% versus 43.8%, and rescue analgesic use was 4.7% versus 5.5%. Recovery measures were also similar, with median time to first flatus of 26 versus 27 hours and median hospital stay of 6 days in both groups. Patient-reported recovery favored oliceridine, with higher median QoR-15 scores of 123 versus 116 and more patients reporting high satisfaction with anesthesia care, at 69.0% versus 50.8%.

Selected adverse events showed a mixed pattern. Dizziness was numerically lower at 4.7% versus 11.7% and opioid-induced respiratory depression was numerically lower at 3.1% versus 10.2%, while shivering was numerically higher at 12.4% versus 3.1% with oliceridine and sufentanil, respectively; these differences did not remain statistically significant after multiplicity correction. Hypotension, hypertension, bradycardia, tachycardia, headache, pruritus, and dry mouth did not differ significantly between groups.