A randomized double-blind placebo-controlled trial of oliceridine, a G protein-biased ligand at the µ-opioid receptor, for management of moderate-to-severe acute pain following bunionectomy

Purpose This study assessed the efficacy and safety of oliceridine in Korean patients undergoing bunionectomy for moderate-to-severe acute postoperative pain.Patients and methods In this randomized, double-blind, placebo-controlled trial, 182 Korean patients experiencing moderate-to-severe acute postoperative pain after bunionectomy were enrolled. Patients received a loading dose of either placebo or oliceridine (1.5 mg), followed by patient-controlled analgesia with oliceridine (0.35 mg or 0.5 mg) or placebo for 48 h. The primary endpoint was the sum of pain intensity differences over 48 h, analyzed using least squares mean change from baseline via analysis of covariance. Secondary endpoints included pain intensity differences, proportion of responders at various time points, and rescue medication use. The trial was registered at ClinicalTrials.gov (NCT05509868).Results Both oliceridine doses demonstrated significant improvement in sum of pain intensity differences over 48 h compared with placebo. The least squares mean differences were 29.14 for the 0.35 mg group and 35.00 for the 0.5 mg group. Pain intensity differences and the proportion of responders were significantly greater starting 5 min post-dose and sustained for 24 h compared with placebo. The odds of requiring rescue pain medication were significantly lower in the oliceridine 0.35 mg and 0.5 mg groups compared with placebo. Adverse events were reported in 52.54% of patients in the 0.35 mg group, 60.32% in the 0.5 mg group, and 40.32% in the placebo group. No serious adverse events occurred in the oliceridine groups.Conclusion Oliceridine provided rapid and significant pain relief after bunionectomy in Korean patients, with no serious adverse events reported, supporting its potential as an effective and well-tolerated analgesic option.