{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T06:24:22Z","timestamp":1786947862354,"version":"build-2736575974"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Objective<\/jats:title>\n \n To determine the median effective dose (ED\n 50<\/jats:sub>\n ) of oliceridine combined with propofol for inhibiting movement response during hysteroscopy in patients with versus without a history of vaginal delivery.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Patients scheduled for hysteroscopy who met the inclusion criteria were stratified into two cohorts: those with no history of vaginal delivery (NVD cohort, including nulliparous women and those with prior cesarean section only) and those with a history of vaginal delivery (VD cohort). Based on the Dixon sequential outcomes, patients were further classified as negative subcohort (successful hysteroscopy, indicating no body movement) or positive subcohort (failed hysteroscopy, indicating body movement). An initial intravenous oliceridine dose of 20\u202f\u03bcg\/kg was administered, followed by propofol 1.5\u202fmg\/kg after 2\u202fmin. Successful induction was defined as a Modified Observer\u2019s Assessment of Alertness\/Sedation (MOAA\/S) score of 0 (no response to trapezius squeeze) and a bispectral index (BIS)\u202f&lt;\u202f60. Intraoperative propofol boluses (0.5\u202fmg\/kg) maintained BIS between 40 and 60. Oliceridine dosing was adjusted using a modified Dixon up-and-down sequential method (dose ratio 1:1.2 between adjacent levels) until at least seven crossover points were recorded. The primary outcome was the ED\n 50<\/jats:sub>\n of oliceridine for suppressing body movement, calculated by probit regression with 95% confidence interval (CI). Cohort comparison of ED\n 50<\/jats:sub>\n was performed using a\n Z<\/jats:italic>\n -test.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The ED\n 50<\/jats:sub>\n of oliceridine for suppressing movement response during hysteroscopy was 21.603\u202f\u03bcg\/kg (95% CI: 19.922\u201323.752) in the NVD cohort and 17.816\u202f\u03bcg\/kg (95% CI: 15.880\u201319.981) in the VD cohort. A formal\n Z<\/jats:italic>\n -test confirmed that the NVD cohort required a 21% higher ED\n 50<\/jats:sub>\n than the VD cohort, and this difference was significant (\n Z<\/jats:italic>\n \u202f=\u202f2.646,\n p<\/jats:italic>\n \u202f=\u202f0.008). No significant baseline differences were observed between the negative and positive subcohorts (all\n p<\/jats:italic>\n \u202f&gt;\u202f0.05). The NVD negative subcohort required higher oliceridine (\n Z<\/jats:italic>\n \u202f=\u202f3.19,\n p<\/jats:italic>\n \u202f&lt;\u202f0.001); the VD negative subcohort consumed more propofol (\n t<\/jats:italic>\n \u202f=\u202f2.11,\n p<\/jats:italic>\n \u202f=\u202f0.038) and oliceridine (\n Z<\/jats:italic>\n \u202f=\u202f3.05,\n p<\/jats:italic>\n \u202f=\u202f0.002). No severe adverse events occurred.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n During painless hysteroscopy, the ED\n 50<\/jats:sub>\n of oliceridine combined with propofol for suppressing movement response was 21% higher in patients without a history of vaginal delivery than in those with such a history. This finding suggests that a history of vaginal delivery may be a useful factor to consider when individualizing initial oliceridine dosing in this setting.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical trial registration<\/jats:title>\n \n ChiCTR2500095126 (\n https:\/\/www.chictr.org.cn<\/jats:ext-link>\n )\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1870477","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:26:14Z","timestamp":1786944374000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of vaginal delivery history on oliceridine ED\u2085\u2080 combined with propofol during painless hysteroscopy: a modified Dixon sequential study"],"prefix":"10.3389","volume":"13","author":[{"given":"Xinyang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, No.215 Hospital of Shaanxi Nuclear Industry","place":["Xianyang, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyu","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No.215 Hospital of Shaanxi Nuclear Industry","place":["Xianyang, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinfeng","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No.215 Hospital of Shaanxi Nuclear Industry","place":["Xianyang, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianlong","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No.215 Hospital of Shaanxi Nuclear Industry","place":["Xianyang, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liuqin","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, No.215 Hospital of Shaanxi Nuclear Industry","place":["Xianyang, Shaanxi, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1877","DOI":"10.1007\/s00404-024-07677-x","article-title":"Hysteroscopy: where did we start, and where are we now? The compelling story of what many considered the \u201cCinderella\u201d of gynecological endoscopy","volume":"310","author":"Vitale","year":"2024","journal-title":"Arch Gynecol Obstet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"338.e1","DOI":"10.1016\/j.ajog.2025.05.023","article-title":"A description of a manual mechanical hysteroscopy tissue removal device for operative hysteroscopy in the office setting","volume":"233","author":"Patel","year":"2025","journal-title":"Am J Obstet Gynecol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"CD007710","DOI":"10.1002\/14651858.CD007710.pub3","article-title":"Pain relief for outpatient hysteroscopy","volume":"10","author":"Ahmad","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"5873","DOI":"10.2147\/DDDT.S484486","article-title":"Effect of intravenous lidocaine infusion on propofol dose and perioperative pain during moderate sedation-analgesia for hysteroscopy: a randomized controlled trial","volume":"18","author":"Yang","year":"2024","journal-title":"Drug Des Devel Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.3390\/diagnostics15101234","article-title":"The incidence of adverse events in adults undergoing procedural sedation with propofol administered by non-anesthetists: a systematic review and meta-analysis","volume":"15","author":"Pig\u00f2","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"3566","DOI":"10.1097\/JS9.0000000000000638","article-title":"The safety and efficacy between remimazolam and propofol in intravenous anesthesia of endoscopy operation: a systematic review and meta-analysis","volume":"109","author":"Zhao","year":"2023","journal-title":"Int J Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"20420986241292231","DOI":"10.1177\/20420986241292231","article-title":"Comparison of a single intravenous infusion of alfentanil or sufentanil combined with target-controlled infusion of propofol for daytime hysteroscopy: a randomized clinical trial","volume":"15","author":"Lei","year":"2024","journal-title":"Ther Adv Drug Saf"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1739","DOI":"10.1007\/s40265-020-01414-9","article-title":"Oliceridine: first approval","volume":"80","author":"Markham","year":"2020","journal-title":"Drugs"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"5942","DOI":"10.1038\/s41467-024-48680-9","article-title":"Whole cervix imaging of collagen, muscle, and cellularity in term and preterm pregnancy","volume":"15","author":"Wu","year":"2024","journal-title":"Nat Commun"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1257","DOI":"10.1093\/biolre\/ioab144","article-title":"Transcriptome and proteome dynamics of cervical remodeling in the mouse during pregnancy\u2020","volume":"105","author":"Nallasamy","year":"2021","journal-title":"Biol Reprod"},{"key":"ref11","first-page":"i","article-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","volume":"894","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"i16","DOI":"10.1093\/bja\/aeq312","article-title":"Dose adjustment of anaesthetics in the morbidly obese","volume":"105","author":"Ingrande","year":"2010","journal-title":"Br J Anaesth"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1097\/01.anes.0000267514.42592.2a","article-title":"Advances in and limitations of up-and-down methodology: a pr\u00e9cis of clinical use, study design, and dose estimation in anesthesia research","volume":"107","author":"Pace","year":"2007","journal-title":"Anesthesiology"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"20420986231214992","DOI":"10.1177\/20420986231214992","article-title":"Modified Dixon sequential method to determine the effective dose of alfentanil compounded with propofol for day-case hysteroscopy","volume":"14","author":"Xu","year":"2023","journal-title":"Ther Adv Drug Saf"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"25153","DOI":"10.1038\/s41598-024-75902-3","article-title":"Effect of different doses of esketamine on the median effective concentration of propofol for inhibiting body movement during hysteroscopy","volume":"14","author":"Wan","year":"2024","journal-title":"Sci Rep"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1097\/LBR.0000000000000784","article-title":"Correlation of vital signs and depth of sedation by modified observer\u2019s assessment of alertness and sedation (MOAA\/S) scale in bronchoscopy","volume":"29","author":"Pastis","year":"2022","journal-title":"J Bronchol Intervent Pulmonol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1016\/j.gie.2015.08.077","article-title":"A randomized, controlled trial to compare the efficacy and safety profile of a dexmedetomidine-ketamine combination with a propofol-fentanyl combination for ERCP","volume":"83","author":"Goyal","year":"2016","journal-title":"Gastrointest Endosc"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1097\/ALN.0000000000000975","article-title":"Practice guidelines for the prevention, detection, and management of respiratory depression associated with neuraxial opioid administration: an updated report by the American Society of Anesthesiologists Task Force on Neuraxial opioids and the American Society of Regional Anesthesia and Pain Medicine","volume":"124","author":"Apfelbaum","year":"2016","journal-title":"Anesthesiology"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s12871-022-01605-9","article-title":"Reported definitions of intraoperative hypotension in adults undergoing non-cardiac surgery under general anaesthesia: a review","volume":"22","author":"Weinberg","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1097\/ALN.0b013e31817302e0","article-title":"Pregnancy increases excitability of mechanosensitive afferents innervating the uterine cervix","volume":"108","author":"Liu","year":"2008","journal-title":"Anesthesiology"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"591","DOI":"10.12122\/j.issn.1673-4254.2022.04.16","article-title":"Impact of vaginal delivery history on anesthesia management of hysteroscopic surgery under intravenous general anesthesia: a cohort study of 99 patients","volume":"42","author":"Yu","year":"2022","journal-title":"Nan Fang Yi Ke Da Xue Xue Bao"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"6903","DOI":"10.2147\/JPR.S557764","article-title":"Determining the effective dose of Oliceridine compounded with propofol for painless hysteroscopy: a prospective modified Dixon sequential dose-finding study","volume":"18","author":"Yang","year":"2025","journal-title":"J Pain Res"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1186\/s12871-025-03411-5","article-title":"Estimation of median effective doses and 95% effective doses of oliceridine combined with propofol for day-case hysteroscopy under total intravenous anesthesia with preserved spontaneous breathing: an up-and-down sequential allocation trial","volume":"25","author":"He","year":"2025","journal-title":"BMC Anesthesiol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1437","DOI":"10.3760\/cma.j.cn131073.20240919.01207","article-title":"Median effective dose of oliceridine combined with propofol for analgesia during induced abortion in patients with different labor histories","volume":"44","author":"Zhang","year":"2024","journal-title":"Chin J Anesthesiol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1456","DOI":"10.3760\/cma.j.cn131073.20240715.01211","article-title":"Median effective dose of oliceridine inhibiting responses to insertion of gastroscope when combined with propofol in obese patients","volume":"44","author":"Jia","year":"2024","journal-title":"Chin J Anesthesiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1620158","DOI":"10.3389\/fphar.2025.1620158","article-title":"Determination of the effective dose of oliceridine combined with propofol using the modified Dixon\u2019s up-and-down method in painless gastroscopy","volume":"16","author":"Cao","year":"2025","journal-title":"Front Pharmacol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1186\/s12871-024-02573-y","article-title":"Characteristics that increase the risk for pain on propofol injection","volume":"24","author":"Leff","year":"2024","journal-title":"BMC Anesthesiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1097\/ALN.0000000000004473","article-title":"Respiratory effects of biased ligand oliceridine in older volunteers: a pharmacokinetic-pharmacodynamic comparison with morphine","volume":"138","author":"Simons","year":"2023","journal-title":"Anesthesiology"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1007\/s40122-020-00232-x","article-title":"Low incidence of opioid-induced respiratory depression observed with Oliceridine regardless of age or body mass index: exploratory analysis from a phase 3 open-label trial in postsurgical pain","volume":"10","author":"Brzezinski","year":"2021","journal-title":"Pain Ther"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"11470","DOI":"10.1038\/s41598-025-95978-9","article-title":"Tolerability of different doses of oliceridine versus traditional opioids in acute pain management: a systematic review and meta-analysis","volume":"15","author":"Liu","year":"2025","journal-title":"Sci Rep"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1007\/s40122-020-00216-x","article-title":"Oliceridine is associated with reduced risk of vomiting and need for rescue Antiemetics compared to morphine: exploratory analysis from two phase 3 randomized placebo and active controlled trials","volume":"10","author":"Beard","year":"2021","journal-title":"Pain Ther"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"5415","DOI":"10.2147\/DDDT.S525471","article-title":"Overview and prospects of the clinical application of oliceridine","volume":"19","author":"Yi","year":"2025","journal-title":"Drug Des Devel Ther"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1093\/bja\/aes276","article-title":"Evidence-based analysis of risk factors for postoperative nausea and vomiting","volume":"109","author":"Apfel","year":"2012","journal-title":"Br J Anaesth"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"100225","DOI":"10.1016\/j.bjao.2023.100225","article-title":"A Monte Carlo simulation study comparing the up and down, biased-coin up and down and continual reassessment methods used to estimate an effective dose (ED95 or ED90) in anaesthesiology research","volume":"8","author":"Fils","year":"2023","journal-title":"BJA Open"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1870477\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:26:18Z","timestamp":1786944378000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1870477\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":34,"alternative-id":["10.3389\/fmed.2026.1870477"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1870477","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"article-number":"1870477"}}