Influence of Oliceridine on the Incidence of Postoperative Nausea and Vomiting in High-Risk Patients Stratified Using Apfel Score After General Anesthesia: A Prospective, Randomized Controlled Clinical Study.

چکیده اصلی

BACKGROUND: As a typical complication, postoperative nausea and vomiting (PONV) usually occurs among patients undergoing general anesthesia surgery, diminishing postoperative satisfaction and recovery. OBJECTIVE: Herein, we applied a new G-protein-biased μ-opioid receptor agonist, oliceridine, to compare its management with fentanyl on PONV among high-risk patients receiving general anesthesia with transversus abdominis plane block (TAP). METHODS: In this prospective, double-blind, randomized controlled study, a total of 280 patients were enrolled for general anesthesia surgery, including laparoscopic cholecystectomy and laparoscopic gynecological surgery. Participants were randomly divided into either the oliceridine group or the fentanyl group at a 1: 1 ratio. Afterwards, the primary outcome was the rate of nausea and vomiting on postoperative day 2. The secondary outcomes comprised the visual analogue scale (VAS) score of PONV, intraoperative analgesic effect, rescue antiemetic treatment, hemodynamic parameters during T1-T5, postoperative pain assessment, hospitalization period, gut function, time of drink and food intake, drainage tube removal, hospitalizations, and perioperative complications. RESULTS: Among the enrolled 279 patients, oliceridine effectively reduced the occurrence of nausea (26.4% versus 12.9%, p = 0.005) and vomiting (24.3% versus 6.5%, p < 0.001). In addition, the postoperative nausea VAS score showed significantly lower in the oliceridine group compared with the fentanyl group (1.40 ± 1.31 versus 2.01 ± 1.79, p = 0.013), accompanied by reduced rescue antiemetic rate (17.1% versus 7.2%, p = 0.011), with stable hemodynamic condition and comparable postoperative recovery. DISCUSSION: According to our study, oliceridine may be a viable substitute for general anesthesia to ameliorate postoperative incidence of PONV, along with its impressive pain control during anesthesia induction and maintenance. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400089121).

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