Research Progress on the Safety of Oliceridine in Perioperative Application

Oliceridine is the first approved biased μ-opioid receptor agonist. It produces analgesia by selectively activating the G protein pathway while minimizing β-arrestin recruitment, a mechanism that theoretically uncouples analgesia from adverse effects. This article systematically reviews the pharmacological basis for the perioperative use of oliceridine, the clinical evidence for its safety, and its value in special patient populations. Studies indicate that at equianalgesic doses, oliceridine is associated with a significantly lower incidence of respiratory depression and better gastrointestinal tolerability compared to conventional opioids. In elderly patients and those with renal or hepatic impairment, no or only mild dose adjustment is required. Cardiovascular and central nervous system adverse effects are manageable, with no risk signals identified beyond those of conventional opioids. Within the framework of multimodal analgesia, oliceridine demonstrates good synergy with other analgesic agents. However, critical questions remain insufficiently addressed, including the risks of long‑term tolerance and dependence, as well as its impact on hard endpoints such as postoperative ileus. Future research should focus on long‑term follow‑up studies and clinical trials centered on bowel function recovery to refine its positioning within Enhanced Recovery After Surgery (ERAS) pathways.