Effect of Oliceridine Fumarate on Emergence Agitation in Elderly Patients Undergoing Total Knee Arthroplasty：A Prospective Randomized Controlled Clinical Study

Imagine the operating room as a high-stakes stage where the body is the star and the anesthesiologist is the director. The goal is to put the star to sleep safely, perform the surgery, and then wake them up smoothly. But sometimes, the "wake-up" scene goes off the rails. This is called emergence agitation. Think of it like a car engine that revs way too high the moment you turn the key; the patient wakes up confused, restless, and maybe even a bit aggressive, which can be dangerous for their fresh surgical wounds and their heart. This is especially tricky for older patients, whose bodies are like older cars that take longer to clear out the "fuel" (drugs) and might sputter a bit more when the engine starts.

For decades, doctors have used powerful painkillers called opioids (like sufentanil) to manage pain after surgery. These are like heavy-duty brakes that stop the pain signal dead in its tracks. However, in older patients, these brakes can sometimes get stuck, causing the car to idle too long or shake violently when trying to start. Scientists have been hunting for a new kind of "brake" that stops the pain effectively but releases the pedal quickly, allowing the patient to wake up calm and clear-headed. Enter oliceridine fumarate, a newer drug designed to be more selective and faster to clear from the body. The big question was: Could this new drug help older patients wake up from knee surgery without the chaotic "revving" of emergence agitation?

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The Great Knee Surgery Wake-Up Race

In this study, researchers set up a fair race to see which drug helps elderly patients wake up from Total Knee Arthroplasty (TKA) surgery more peacefully. They gathered 114 patients aged 65 and older, all scheduled for elective knee replacement. To make sure the results were fair, they split the group into two teams using a random draw, like flipping a coin. One team got the standard drug, sufentanil (Team S), and the other team got the new contender, oliceridine fumarate (Team O).

The setup was a "double-blind" trial, meaning neither the patients nor the doctors knew who got which drug until the very end. Everyone got the same pre-surgery nerve blocks (a local anesthetic shot to numb the leg) and the same general anesthesia to keep them asleep. The only difference was the painkiller they received right as the surgery was finishing and the one they used for pain control afterward.

The Results: A Calmer Awakening

The results were pretty clear. When it came to emergence agitation (that confused, restless waking-up state), Team O (the oliceridine group) had a much smoother ride. Only 4 out of 57 patients in Team O (about 7.02%) experienced agitation. In contrast, Team S (the sufentanil group) had 13 out of 57 patients (about 22.81%) who got agitated. That's a significant difference, suggesting that the new drug is much better at keeping the "engine" stable during the wake-up.

It wasn't just about who got agitated, but how bad it was. The researchers used a scale called the Riker Sedation-Agitation Scale to measure the intensity. The median score for Team O was 4.0 (calm and cooperative), while Team S was 4.5 (leaning toward agitated). The study found that the new drug not only reduced the number of agitated patients but also made the agitation less severe when it did happen.

The Heartbeat and Blood Pressure Check

Waking up from surgery can be a shock to the system, causing heart rates and blood pressure to spike. The researchers checked these vital signs at three moments: before the drugs were given (T0), 5 minutes after the breathing tube was removed (T1), and 30 minutes after (T2).

At the 5-minute mark (T1), Team O's heart rates and blood pressure were much more stable. Their heart rates averaged 77.3 beats/min and blood pressure 103.5 mmHg, whereas Team S spiked to 82.75 beats/min and 115.2 mmHg. The paper notes that these fluctuations were significantly smaller in the oliceridine group. By the 30-minute mark (T2), both groups had settled down, and their numbers were similar again, showing that the new drug helped the body transition more gently through the critical first few minutes of waking up.

Side Effects: The "Crash" After the Ride

Every medication has a potential "crash" or side effects. The study looked at common issues like nausea, vomiting, dizziness, and drowsiness. Team O had fewer of these problems.

• Nausea and vomiting: 10.53% in Team O vs. 26.32% in Team S.
• Dizziness/drowsiness: 7.02% in Team O vs. 21.05% in Team S.

Interestingly, neither group had many cases of respiratory depression (slowed breathing), and no one in the oliceridine group had this issue, while 3 patients in the sufentanil group did (though the difference wasn't statistically huge, it was a trend in the right direction). The overall rate of adverse reactions was 10.53% for the new drug compared to 26.32% for the old one.

The Bottom Line

This study suggests that for elderly patients getting a new knee, swapping the traditional painkiller (sufentanil) for the newer oliceridine fumarate can lead to a much calmer, safer, and faster recovery from anesthesia. It appears to be a "gentler" option that keeps the heart steady and reduces the risk of that chaotic, confused waking-up feeling.

However, the authors are careful to note that this was a single-center study with a specific group of patients. While the results are promising, they suggest that more large-scale studies are needed to confirm these findings across different hospitals and patient types. For now, though, it looks like oliceridine fumarate is a strong new player in the game of helping older patients wake up from knee surgery without the drama.