Oliceridine Versus Morphine After Thoracoscopic Surgery

Key Takeaways

• Oliceridine was associated with faster extubation and a quicker return to alertness during early postoperative recovery.
• Oliceridine was also associated with lower pain scores at 5 minutes, less rescue analgesia use, and fewer adverse events during the PACU stay.
• QoR-15, first oral intake, ambulation, and gastrointestinal adverse events were not significantly different at 24 hours, and the observed advantage was limited to the immediate postoperative period.

In a randomized trial after elective video-assisted thoracoscopic surgery, postoperative intravenous oliceridine was linked to faster extubation than morphine, occurring in 12 ± 4 versus 20 ± 8 minutes. The primary endpoint favored oliceridine by a mean difference of -7.6 minutes, with a 95% confidence interval from -10.4 to -4.9 and P<0.001. The comparison focused on postoperative intravenous oliceridine versus morphine in adults recovering from VATS. Later recovery measures did not show the same pattern at 24 hours. The differences were concentrated in the earliest phase of postoperative recovery.

The randomized clinical trial enrolled 100 adults aged 18 to 75 years undergoing elective thoracoscopic surgery, with 95 completing follow-up after 1:1 assignment to oliceridine or morphine. At surgery’s end, patients received an intravenous loading dose of oliceridine 1.5 mg or morphine 4 mg, followed by PACU doses of 0.5 mg or 1 mg as needed. Time to extubation was the primary endpoint. Secondary outcomes were alertness recovery, NRS pain scores, rescue analgesia, PACU adverse events, QoR-15, oral intake, ambulation, and 24-hour gastrointestinal events. Standardized anesthesia protocols were used, and the trial followed CONSORT guidance. The outcome framework centered on recovery during the PACU stay and across the first postoperative day.

Among immediate recovery measures, alertness returned sooner with oliceridine, at 18 ± 5 minutes versus 29 ± 10 minutes with morphine, with P<0.001. Pain scores 5 minutes after extubation were lower with oliceridine, 3 versus 5 on the NRS, and this difference was significant at P<0.001. Rescue analgesia was required less often in the oliceridine group, 45.7% versus 77.6%, with P=0.001. These measures moved in the same direction during PACU emergence, concentrating the between-group differences in the earliest postoperative interval. The immediate recovery profile included quicker alertness, lower early pain scores, and less frequent supplemental opioid use.

Overall PACU adverse events occurred in 19.6% of patients given oliceridine and 38.8% given morphine, a difference that reached statistical significance with P=0.04. By 24 hours, no significant differences were seen in QoR-15 scores, time to first oral intake, time to first ambulation, or gastrointestinal adverse events. Those later assessments did not separate on patient-reported recovery or on basic milestones such as eating and ambulation. The authors limited the observed advantage to the immediate postoperative period. The trial separated early PACU recovery differences from the absence of detectable divergence in measured 24-hour recovery endpoints.