Tegileridine after caesarean: less nausea, same pain relief, in a small trial

Design

Randomised, double-blind trial

Population

94 women having elective caesarean delivery (92 analysed), China

Primary outcome

Postoperative nausea and vomiting within 48 hours

Effect

6.5% vs 23.9%; RR 0.27 (95% CI 0.08 to 0.91); absolute difference -17.4%

A double-blind randomised trial in China compared patient-controlled intravenous analgesia with tegileridine 5 mg against sufentanil 100 micrograms in 94 women having elective caesarean delivery; 92 completed. Tegileridine is a biased mu-opioid agonist designed to keep analgesia while causing fewer opioid side effects.

Nausea and vomiting over 48 hours fell from 23.9% to 6.5% (RR 0.27, 95% CI 0.08 to 0.91; absolute difference -17.4%), and dizziness from 26.1% to 6.5%. Pain scores, bolus counts, rescue analgesia, time to walking and length of stay did not differ. Quality of Recovery-15 scores at 48 hours were higher with tegileridine (median 125 vs 113).

Tegileridine is not available in India and the trial is small and single-country. The wider point is that nausea, not pain, is often what spoils recovery after caesarean, and that remains worth targeting with the tools already on the shelf.

• Ask about nausea and dizziness at each post-caesarean review, not only pain scores.
• Give antiemetic prophylaxis for women on opioid PCA after caesarean.
• Use opioid-sparing multimodal analgesia: regular paracetamol, an NSAID where not contraindicated, and neuraxial morphine where used.
• Treat tegileridine as investigational for Indian practice; it is not available here.

Why it matters

It shows the opioid side effect that most delays recovery can be cut without losing analgesia, a goal worth pursuing with existing drugs.

Don't overread it

With 92 women and a wide confidence interval, the size of the nausea benefit is uncertain and needs confirming in larger trials.

The statistics, in plain English

A risk ratio of 0.27 means nausea was about a quarter as common, but the interval runs from 0.08 to 0.91, so the true reduction could be anywhere from large to marginal. Small trials often overstate effects.

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