Comparison of oliceridine and sufentanil in patient - controlled intravenous analgesia for post - thoracoscopic nausea and vomiting: a prospective, double - blind, randomized controlled trial.

Objective: To compare oliceridine and sufentanil in patient-controlled intravenous analgesia (PCIA) for reducing postoperative nausea and vomiting (PONV) in thoracoscopic surgery patients. Methods: A prospective, double-blind, randomized controlled trial enrolled 130 patients at the Affiliated Hospital of Xuzhou Medical University from December 2024 to February 2025. Patients were randomly assigned to oliceridine (Group O, n = 65) or sufentanil (Group S, n = 65) PCIA groups. General anesthesia combined with nerve block anesthesia was used intraoperatively, followed by PCIA post-surgery. The primary outcome was PONV incidence within 48 h. Secondary outcomes included nausea and vomiting scores, pain scores, rescue analgesia and antiemetic use, recovery indicators, and adverse reactions. Results: Baseline and intraoperative characteristics were similar between groups. The primary outcome (48-h PONV incidence) was significantly lower in Group O (32.3% [21/65]) than Group S (50.8% [33/65]; P = 0.033; OR = 0.46, 95% CI [0.23-0.94]), especially within 24 h postoperatively. Moderate-to-severe PONV was also less frequent in Group O (18.5% vs. 38.5%, P = 0.012; OR = 0.36, 95% CI [0.16-0.81]). Early postoperative pain scores were similar, but Group S had higher Visual Analogue Scale (VAS) scores after 12 h (P < 0.05), though the absolute differences were small (e.g., median resting VAS of 0 vs. 1 at 48 h). Rescue analgesic demand and PCIA use showed no significant difference. Group O had significantly higher Quality of Recovery-15 (QoR-15) scores (median difference at 24 h: 5.0 [95% CI 1.2-8.8]; P < 0.05) and significantly lower Athens Insomnia Scale scores (median difference at 24 h: 1.0 [95% CI -2.3 to -0.5]; P < 0.05) compared to Group S. Adverse reaction rates, including dizziness, nightmares, hallucinations, respiratory depression, dry mouth, allergy, and bradycardia, were similar between groups. Conclusion: In high-PONV-risk thoracoscopic surgery, oliceridine-based PCIA significantly reduced PONV incidence compared to sufentanil (32.3% vs. 50.8%, P = 0.033), while also demonstrating superior recovery quality (QoR-15) and sleep outcomes (AIS). This establishes oliceridine as a procedure-specific analgesic option for enhancing recovery beyond conventional opioid-sparing effects.