Oliceridine versus sufentanil for anesthesia induction in strabismus surgery: a randomized double-blind non-inferiority trial

Objective To compare efficacy of oliceridine versus sufentanil given during general‑anesthesia induction in patients undergoing strabismus‑correction surgery. Methods 288 patients scheduled for elective strabismus correction under general anesthesia were enrolled. Inclusion criteria had no age or sex restrictions, with ASA Ⅰ‑Ⅱ. Due to scarcity of adult strabismus surgeries, all participants were aged 3‑19 years, and were randomized to group S (sufentanil) or group A (oliceridine). All patients received routine general anesthesia induction and maintenance. The induction regimen consisted of midazolam 0.05 mg/kg, cisatracurium 0.2 mg/kg, propofol 1.5–2.0 mg/kg, combined with sufentanil 0.4 μg/kg or oliceridine 0.08 mg/kg. Anesthesia was maintained with continuous infusion of propofol and remifentanil. Infusion rates were adjusted according to blood pressure and heart rate, and additional boluses of propofol or remifentanil were administered when necessary. No study‑assigned opioids (oliceridine or sufentanil given at induction) were re‑administered in either group. All patients were transferred to the post-anesthesia care unit (PACU) after surgery. The primary outcome was the adequate intraoperative analgesia rate, defined as the percentage of patients with adequate intraoperative analgesia among all patients who received anesthesia induction and completed surgery. Adequate intraoperative analgesia was defined as heart rate and blood pressure fluctuations less than 20% from baseline in response to laryngeal mask placement, skin incision and surgical exploration; absence of purposeful movement, frowning, fist‑clenching, tearing and other nociceptive responses; and no requirement for urgent rescue analgesics. Secondary outcomes included the incidence of cough during anesthesia induction and intraoperative oculocardiac reflex; surgical and anesthetic parameters (operation duration, emergence time, PACU stay time, Ricker Sedation-Agitation Scale score, total dosage of propofol and mean intraoperative remifentanil infusion rate); 24-hour visual analog scale (VAS) scores for eye pain at rest and during eye movement; incidence of postoperative adverse reactions (nausea and vomiting, dizziness and somnolence, respiratory depression, constipation and urinary retention); length of hospital stay and proportion of patients requiring postoperative rescue analgesia. Results There was no significant difference in the rate of adequate intraoperative analgesia between the two groups, and the non-inferiority of oliceridine was verified. The incidence of cough during anesthesia induction in Group A was significantly lower than that in Group S (P < 0.05). No significant differences were found in the total dosage of propofol and mean intraoperative remifentanil infusion rate between the two groups (P > 0.05). There were also no statistical differences in the incidence of intraoperative oculocardiac reflex, operation duration, PACU stay time and Ricker Sedation-Agitation Scale score. The emergence time in Group A was shorter than that in Group S (P < 0.05). No significant differences were observed in 24-hour postoperative VAS scores for eye pain, incidence of adverse reactions, length of hospital stay and rate of postoperative rescue analgesia between the two groups. Conclusion Oliceridine 0.08 mg/kg was non-inferior to sufentanil 0.4 μg/kg in providing intraoperative analgesia for patients undergoing strabismus correction surgery. Compared with sufentanil, oliceridine was associated with a lower incidence of cough during induction and shorter emergence and extubation times. Trial registration Registered in the ClinicalTrials.gov (NCT07112157) on July 25, 2025.