Effects of Oliceridine versus Sufentanil on Postoperative Nausea and Vomiting in Patients Undergoing Modified Radical Mastectomy: A Double-Blind Randomized Controlled Trial

Purpose: Compare the effects of oliceridine and sufentanil on reducing postoperative nausea and vomiting (PONV) in patients undergoing modified radical mastectomy (MRM). Patients and Methods: In this single-center, double-blind, randomized controlled trial conducted from June 2024 to March 2025, 176 female patients aged 18– 75 years undergoing modified radical mastectomy were enrolled. Participants were randomly assigned (1:1) to receive either oliceridine (Group O) or sufentanil (Group S) during anesthesia induction. The primary outcome was the incidence of PONV within 48 h postsurgery. Secondary outcomes included PONV severity, Visual Analog Scale (VAS) pain scores at rest and during activities, use of rescue antiemetics and rescue analgesia, cardiovascular adverse events after induction, changes in heart rate (HR) and mean arterial pressure (MAP) around tracheal intubation, duration of anesthesia and surgery, and other drug-related adverse events after emergence. Results: Oliceridine significantly reduced the incidence of PONV within 48 h compared with sufentanil (20.5% vs 39.8%; p = 0.005). PONV severity at 48 h was also lower in the oliceridine group (median [IQR] 0.0 [0.0– 0.0] vs 0.0 [0.0– 5.0]; p = 0.016), and the incidence of PONV within 24 h was reduced (13.6% vs 27.3%; p = 0.025). Analgesic efficacy, as reflected by VAS scores and the need for rescue analgesia, was comparable between groups. Hemodynamic profiles and the incidence of cardiovascular adverse events were similar, although numerically fewer hypotensive and bradycardic episodes occurred with oliceridine. Conclusion: In patients undergoing modified radical mastectomy, oliceridine used for anesthetic induction and perioperative analgesia significantly reduced the incidence and severity of PONV compared with sufentanil, while maintaining adequate analgesia and a favorable safety profile. Oliceridine may represent a safer opioid option in breast cancer surgery, with a lower burden of opioid related adverse events (ORADEs). Keywords: postoperative nausea and vomiting, PONV, opioid-related adverse events, ORADEs, biased ligand, visual analogue scale, VAS, opioid-free anesthesia, OFA, opioid-sparing anesthesia, OSA