Evaluating oliceridine as a treatment option for moderate to severe acute post-operative pain in adults

ABSTRACT

Introduction

Despite the advances in regional anesthesia and non-opioid systemic analgesia, opioids remain the primary rescue analgesic for moderate to severe pain. However, the risks and side effects of opioid medications are well documented. Oliceridine is a novel opioid receptor agonist which is thought to have less risk of adverse events, such as postoperative nausea and vomiting (PONV) and respiratory depression.

Areas Covered

In this review, the authors discuss the limitations of the current opioid and non-opioid analgesic options. They also review the pharmacokinetics of oliceridine, its analgesic efficacy, and risk of adverse events; and its added clinical value in managing moderate to severe pain.

Expert opinion

Despite the advances in regional anesthesia and multimodal systemic analgesia, opioid free analgesia is only feasible in selected procedures and patients. Oliceridine is effective in the management of moderate to severe pain and appears to be associated with lower risk of nausea and vomiting. The risk of sedation and respiratory depression associated with oliceridine will require further study. The availability of an opioid agonist with a better side effect profile could potentially change the current paradigm of opioid avoidance in postoperative pain management.

KEYWORDS:

• Oliceridine
• pain
• post-operative pain
• anesthesia
• opioids

Article Highlights

• Oliceridine is a biased opioid receptor ligand that preferentially activates the G-protein coupled intracellular pathway while limiting the activation of the β-arrestin pathway.

• Oliceridine has demonstrated comparable analgesic efficacy to morphine when administered intravenously.

• Compared to conventional opioids such as morphine, oliceridine is associated with significantly lower risk of PONV.

• There is limited evidence to indicate that oliceridine may reduce the risk of opioid associated respiratory depression.

• Limited pre-clinical studies suggest that oliceridine may be associated with lower risk of tolerance, dependence, and opioid-induced hyperalgesia.

Acknowledgments

The authors would like to thank Alexandra Leibholz for the production of the visual illustrations displayed in this review.

Declaration of Interest

TJ Gan has received honoraria from Acacia, Edwards, Masimo, Medtronic, Merck & Co. and Mallinckrodt. Furthermore, SD Bergese has received funding for his clinical trial work from Acacia. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.