A prospective, historical-controlled evaluation of oliceridine for moderate or severe pain in patients with acute burn injuries (RELIEVE).

Abstract

Oliceridine, a biased, selective opioid agonist, has shown a 3-fold preferential activation of the G-protein (i.e., analgesia) over β-arrestin pathway. β-arrestin activation is believed to be associated with higher adverse events, such as constipation, respiratory depression, and desensitization. There is no literature of use in patients with burn injuries. We hypothesized the use of oliceridine would provide adequate and safe analgesia after acute burn injury. Ten patients received oliceridine as their sole opioid for up to 7 days, which was compared to a random, historical cohort receiving standard of care (i.e, fentanyl, oxycodone, hydromorphone, and morphine). The historical control group was initially matched 2:1 (though 2 patients were ultimately excluded) with the oliceridine group according to age, percent total body surface area burned (TBSA), and number of operations. No patient had a history of known opioid, cocaine, or methamphetamine use, as this was an exclusion criterion for the prospectively enrolled group. Baseline numerical rating scale (NRS) was similar for both groups [9 (7.8, 10) vs 9.5 (8.8, 10); p = 0.360). Over the 7-day period, mean daily pain scores significantly decreased in both groups. However, use of oliceridine was associated with a significantly larger decrease in mean pain score [-0.74 (-1.36, -0.12), p = 0.0215]. There was no difference in average daily morphine milligram equivalents (MME) [-14.02 (-67.22, 39.19), p = 0.5939]. There were no unexpected adverse events related to oliceridine. Oliceridine demonstrated significant pain relief, which was maintained over the 7-day study period. The control group demonstrated initial relief, which was not maintained despite similar MME.