Effect of oliceridine pretreatment on etomidate-induced myoclonus: a prospective, randomized, double-blind, controlled study

Purpose Etomidate often induces adverse effects such as myoclonus during anesthesia induction, thereby increasing perioperative risks for patients to some extent. Oliceridine is a novel opioid with fewer opioid-related adverse reactions. This study aims to investigate the effect of oliceridine pretreatment on etomidate-induced myoclonus. Patients and methods This study is a prospective, randomized, double-blind, controlled study. Patients scheduled for elective surgery under general anesthesia were selected and randomly divided into the oliceridine group (Group O) and the normal saline group (Group C), with 45 patients in each group. Two minutes before etomidate administration, Group O and Group C were given 0.02 mg/kg oliceridine and an equal volume of normal saline, respectively. Primary outcome measure: the incidence of etomidate-induced myoclonus. Secondary outcome measures: the severity of etomidate-induced myoclonus, as well as adverse reactions and hemodynamic changes occurring during the observation period. Results The incidence of myoclonus in Group O was significantly lower than that in Group C (13.3% vs. 51.1%, RR = 0.45, 95% confidence interval [95%CI] = 0.310–0.667, p < 0.001). Compared with Group C, the incidence of myoclonus in Group O was reduced by 37.8%. Among the secondary outcomes, the severity of myoclonus in Group O was significantly lower than that in Group C ( p < 0.001). The time to loss of consciousness in Group O was shorter than that in Group C (43.24 s ± 6.89 vs. 48.2 s ± 10.34, p = 0.008), and there was a statistically significant difference in the BIS values between the two groups at 2 min after etomidate induction (T2) (44.23 ± 9.38 vs. 53.75 ± 16.54, p = 0.001). In addition, there were no statistically significant differences in adverse reactions or hemodynamic changes between the two groups during the observation period. Conclusion Pretreatment with oliceridine can significantly reduce the incidence of etomidate-induced myoclonus. Therefore, oliceridine can be used as a new pretreatment strategy when etomidate is employed for anesthetic induction. Clinical trial registration https://www.chictr.org.cn/searchproj.html , identifier ChiCTR2500108944.