The Satisfactory Analgesia and Minimal Emesis of Elderly Patients After Thoracoscopic Lung Surgery: Oliceridine versus Sufentanil in a Randomized Controlled Trial

Yongliang Cai, Yihao Jiang, Qingwei Zhang, Jianjun Yang, Zhongyun Wang,* Heliang Sun* Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, Nanjing, 210000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Heliang Sun; Zhongyun Wang, Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, Jiangsu, 210000, People’s Republic of China, Email njmu528@163.com; zywang1970@126.comPurpose: To compare oliceridine with sufentanil for the proportion of elderly patients achieving satisfactory analgesia with minimal emesis (SAME) after thoracoscopic lung surgery.Methods: This prospective, double-blind, randomized controlled trial enrolled elderly patients aged 65– 80 years scheduled for thoracoscopic lung surgery to receive patient-controlled intravenous analgesia with either oliceridine or sufentanil. The primary outcome was the proportion of patients achieving SAME within the first 3 postoperative days, defined as a daily average coughing numerical rating scale (NRS) pain score < 4 and daily highest postoperative nausea and vomiting (PONV) score < 2. The secondary outcomes included NRS pain scores, rescue analgesia, 15-item Quality of Recovery (QoR-15) scores, safety outcomes, time to ambulation, and postoperative length of stay.Results: Among the 247 patients analyzed, oliceridine was associated with a higher proportion of patients achieving the SAME endpoint within the first 3 postoperative days compared with sufentanil (46.3% vs 32.3%; P = 0.023). Furthermore, the patients with oliceridine demonstrated lower NRS scores on POD1 (3.6 ± 1.9 vs 4.4 ± 2.1; P = 0.018) and POD2 (3.2 ± 1.2 vs 3.7 ± 1.3; P = 0.039), less requirement for rescue analgesia (P = 0.021), and higher QoR-15 scores on POD1 (P < 0.001) and POD2 (P = 0.010). Oliceridine also reduced the time to first ambulation (19 h [16, 22] vs 22 h [18, 25]; P < 0.001). No significant difference was observed in postoperative length of stay or safety outcomes.Conclusion: Oliceridine, compared with sufentanil for postoperative analgesia, increased the proportion of achieving SAME within the first 3 PODs, provided better analgesia, and improved postoperative recovery quality with comparable safety outcomes for elderly patients undergoing thoracoscopic lung surgery.Trial Registration: www.chictr.org.cn, ChiCTR2500102213.