A Comparison of Oliceridine versus Sufentanil for Patient-Controlled Analgesia After Total Knee Arthroplasty in Elderly Patients: A Double-Blinded Randomized Controlled Study

Purpose: Oliceridine is a G protein-biased μ-opioid receptor agonist, maintaining potent analgesic effects and simultaneously lessening disadvantageous reactions. This study is intended to compare Oliceridine and sufentanil patient-controlled analgesia (PCA) for postoperative analgesia in elderly patients suffering from knee arthroplasty. Patients and Methods: A total of 138 patients scheduled for knee arthroplasty were randomized to receive postoperative PCA with either Oliceridine (2 μg kg − 1 mL − 1 ) or sufentanil (0.02 μg kg − 1 mL − 1 ). To preserve blinding, identical volume-based settings (mL) were used for both groups. The PCA regimen comprised a 1 mL loading dose (equivalent to 2 μg kg − 1 Oliceridine or 0.02 μg kg − 1 sufentanil), a background infusion of 2 mL h − 1 , and a 2 mL bolus dose with a 10-minute lockout interval. Outcomes for systematic assessment included the sum of pain intensity difference (SPID), numeric rating scale (NRS) scores, and the incidence of postoperative nausea, vomiting and respiratory depression. Results: Subjects in this research were 71.5 years on average, and 83% were female. Throughout 48 h postoperatively, the mean difference between Group Oliceridine and Group sufentanil was − 7.13 (95% CI: − 24.26 to 10.00); the upper bound of the 95% CI did not exceed the pre-specified non-inferiority margin of 10, thereby meeting the non-inferiority criterion. Aside from that, nausea (33.33% vs. 50.72%; P = 0.039) and vomiting (14.49% vs. 34.78%; P = 0.006) presented much lower incidence in Group Oliceridine within 48 h postoperative. Conclusion: Oliceridine may have non-inferior analgesic efficacy to sufentanil and is associated with a lowered incidence of nausea and vomiting within 48 h. Plain Language Summary: Many older adults need strong pain relief after knee replacement surgery. While common opioid pain medications work well, they often cause bothersome side effects like nausea and vomiting. Finding a pain control option that is both effective and easier to tolerate is an important goal. Our research team compared a newer pain medication, oliceridine (also known as TRV130), with a commonly used opioid, sufentanil. We studied 138 older patients who used a patient-controlled pump to manage their pain for two days after knee surgery. We tracked how their pain was controlled and recorded any side effects. We found that pain relief with oliceridine was non-inferior to sufentanil. The key difference was in side effects: significantly fewer patients who received oliceridine experienced nausea or vomiting. This means that for older adults recovering from knee surgery, oliceridine offers a potentially better-tolerated choice for effective pain control, with less of the stomach-related side effects that can make recovery unpleasant. Keywords: patient-controlled analgesia, oliceridine, pain measurement, postoperative nausea and vomiting, PONV, TRV130