Comparison of Oliceridine and Morphine in Postoperative Analgesia in Laparoscopic Total Hysterectomy, a Randomized Double-Blind Controlled Trial

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Purpose: Compare the analgesic efficacy and safety profiles of oliceridine and morphine in patient-controlled intravenous analgesia (PCIA) after laparoscopic total hysterectomy. Materials and Methods: This prospective, double-blind trial randomly allocated 60 patients undergoing elective laparoscopic total hysterectomy in a 1:1 ratio to receive either oliceridine (group O) or morphine (group M) via PCIA. The primary endpoint was cough numerical rating scale (NRS) scores 6 h postoperatively. Secondary outcomes included cough/resting NRS scores at 0.5, 2, 6, 12, 24, and 48 h (6 h cough NRS score excluded); 24-hour postoperative recovery quality using 15-item Quality of Recovery (QoR-15) scale. Exploratory indicators including hemodynamic parameters and peripheral capillary oxygen saturation (SpO 2 ) post intravenous analgesic loading dose. Safety indicators represented by the incidence of adverse events occurring within 72 hours postoperatively. Results: Group O demonstrated superior early analgesia with lower resting NRS (1.0 [1.0,1.0] vs 1.5 [1.0,2.0]; P = 0.019) and cough NRS (1.0 [1.0– 2.0] vs 2.5 [1.0– 3.0]; P = 0.003) at 0.5 h compared with group M, and analgesic efficacy was comparable thereafter (all P > 0.05). Group O exhibited lower nausea/vomiting (33.3% vs 73.3%, P = 0.002) and constipation (20.0% vs 53.3%, P = 0.007) rates, along with higher 24-h QoR-15 scores (125.27 ± 10.11 vs 119.67 ± 8.49; P = 0.024). Higher SpO 2 in group O at 5 min ( P = 0.003) and 10 min ( P = 0.033) postloading doses. Meanwhile, group M demonstrated transient heart rate (HR) elevation at 5 min postloading dose, whereas group O exhibited no significant HR increases at any time point. Conclusion: Oliceridine demonstrates analgesic efficacy comparable to morphine after laparoscopic total hysterectomy but exhibits superior safety by significantly reducing opioid-related adverse events and potentially accelerating postoperative recovery. Keywords: oliceridine, morphine, biased μ-opioid receptor agonist, postoperative analgesia, opioid-related adverse events, laparoscopic total hysterectomy

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