Oliceridine Matches Sufentanil for Strabismus Surgery Anesthesia in Children’s Trial

A randomized, double-blind, non-inferiority trial published in BMC Anesthesiology reports that the opioid oliceridine, given at 0.08 mg/kg during general anesthesia induction, was non-inferior to the established opioid sufentanil at 0.4 μg/kg for providing intraoperative analgesia in patients undergoing strabismus correction surgery. The study also found that patients receiving oliceridine coughed less often during induction and emerged from anesthesia more quickly than those given sufentanil.

The trial enrolled 288 patients scheduled for elective strabismus correction under general anesthesia. Because adult strabismus surgeries are scarce, all participants were aged between 3 and 19 years, and there were no age or sex restrictions beyond ASA physical status I to II. Participants were randomized to a sufentanil group or an oliceridine group. The trial was registered with ClinicalTrials.gov as NCT07112157 on July 25, 2025.

All patients received the same routine general anesthesia induction and maintenance. Induction consisted of midazolam 0.05 mg/kg, cisatracurium 0.2 mg/kg, and propofol 1.5 to 2.0 mg/kg, combined with either sufentanil 0.4 μg/kg or oliceridine 0.08 mg/kg depending on group assignment. Anesthesia was maintained with a continuous infusion of propofol and remifentanil, with infusion rates adjusted according to blood pressure and heart rate, and additional boluses of propofol or remifentanil given when necessary. Neither study-assigned opioid was re-administered after induction in either group, and all patients were transferred to the post-anesthesia care unit after surgery.

The primary outcome was the rate of adequate intraoperative analgesia, defined as the percentage of patients achieving adequate analgesia among all who received induction and completed surgery. Adequate analgesia required that heart rate and blood pressure fluctuate by less than 20 percent from baseline in response to laryngeal mask placement, skin incision, and surgical exploration; that patients show no purposeful movement, frowning, fist-clenching, tearing, or other nociceptive responses; and that no urgent rescue analgesics be required.

On this primary measure, the trial found no significant difference between the two groups, and the authors concluded that non-inferiority of oliceridine was verified.

Several secondary outcomes favored oliceridine. The incidence of cough during anesthesia induction was significantly lower in the oliceridine group than in the sufentanil group, a difference the authors report at a statistical threshold of P less than 0.05.

Emergence time was also shorter in the oliceridine group, again at P less than 0.05, meaning patients receiving oliceridine woke from anesthesia sooner. No significant differences were found between the groups in the total dosage of propofol used or the mean intraoperative remifentanil infusion rate, indicating that the maintenance anesthetic requirements were similar regardless of which induction opioid was given.

The remaining secondary outcomes showed no statistical differences between the groups. These included the incidence of the intraoperative oculocardiac reflex, operation duration, PACU stay time, and Ricker Sedation-Agitation Scale score. Twenty-four-hour postoperative visual analog scale scores for eye pain, both at rest and during eye movement, were similar between groups, as were the incidence of adverse reactions such as nausea and vomiting, dizziness and somnolence, respiratory depression, constipation, and urinary retention, along with length of hospital stay and the proportion of patients requiring postoperative rescue analgesia.

The authors conclude that oliceridine 0.08 mg/kg was non-inferior to sufentanil 0.4 μg/kg in providing intraoperative analgesia for strabismus correction surgery, and that compared with sufentanil, oliceridine was associated with a lower incidence of cough during induction and shorter emergence and extubation times. As with any single trial, the findings apply to the population studied, predominantly children and adolescents aged 3 to 19 undergoing elective strabismus correction, and the published version was shared early as a peer-reviewed accepted manuscript subject to further edits before the final version of record.

Subject of Research: Oliceridine versus sufentanil for anesthesia induction in strabismus correction surgery

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

Article References: Tang, F., Fu, N., & Zhang, J. (2026). Oliceridine versus sufentanil for anesthesia induction in strabismus surgery: a randomized double-blind non-inferiority trial. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-04326-5

Image Credits: AI Generated

DOI: 10.1186/s12871-026-04326-5

Keywords: oliceridine, sufentanil, strabismus surgery, anesthesia induction, non-inferiority trial, randomized controlled trial, cough during induction, emergence time, pediatric anesthesia, postoperative outcomes, versus, anesthesia