Anrikefon-based Patient-controlled Intravenous Analgesia Following Laparoscopic Surgery

NCT07525986 | Recruiting Phase 4

• 1 other identifier: 2025R0444-0003
• Study Type: interventional
• Target: 140
• Locations: 1 country
• Sites: 1

Brief Summary

Visceral pain following laparoscopic surgery is frequently underestimated, yet it is associated with a range of adverse outcomes. Effective visceral pain management should constitute an essential component of postoperative analgesic strategies following laparoscopic procedures. However, conventional analgesic agents, including μ-opioid receptor agonists, lack specificity for visceral pain. Anrikefon, a novel selective peripheral κ-opioid receptor agonist, demonstrates unique efficacy in alleviating visceral pain with a favorable safety profile. Preliminary studies showed that a single intravenous dose of anrikefon effectively alleviates postoperative pain after abdominal surgery with a low risk of adverse effects. The investigators hypothesize that an appropriate dosing regimen of anrikefon administered via patient-controlled intravenous analgesia (PCIA) pump, as part of a multimodal analgesic strategy, can specifically target and alleviate visceral pain after laparoscopic surgery, thereby achieving comprehensive postoperative analgesia.

Conditions

Laparoscopic Surgery; Visceral Pain, Postoperative; Anrikefon; Patient-controlled Intravenous Analgesia

Keywords

Laparoscopic surgery; Visceral pain, Postoperative; Anrikefon; Patient-controlled intravenous analgesia

Outcome Measures

Primary Outcomes (1)

• Area under curve (AUC) of visceral pain intensity with movement within 48 hours

  The AUC of pain intensity is calculated by summing the trapezoidal areas under the pain intensity data points between each pair of consecutive observations within 48 hours after intervention. Visceral pain intensity with movement will be assessed at 0, 0.5, 1, 2, 6, 12, 24, 36, and 48 hours after intervention using an 11-point Numeric Rating Scale (0 = no pain, 10 = the worst pain).

  Within 48 hours after intervention.

Secondary Outcomes (3)

• AUC of visceral pain intensity at rest within 48 hours

  Within 48 hours after intervention.

• AUC of overall pain intensity with movement within 48 hours

  Within 48 hours after intervention.

• AUC of overall pain intensity at rest within 48 hours

  Within 48 hours after intervention.

Other Outcomes (9)

• Quality of recovery at 24 hours after surgery

  At the 24th hour after surgery.

• Rate of rescue analgesia within 48 hours after intervention

  Within 48 hours after intervention.

• AUC of somatic pain intensity at rest within 48 hours

  Within 48 hours after intervention.

Study Arms (4)

High-dose anrikefon group

EXPERIMENTAL

Postoperative patient-controlled intravenous analgesia is established with anrikefon 1000 μg, diluted with normal saline to 100 ml, and programmed to administer an initial loading dose of 8 ml, followed by 4-ml boluses with a lockout interval of 10 minutes and no continuous background infusion.

Drug: High-dose anrikefon

Medium-dose anrikefon group

EXPERIMENTAL

Postoperative patient-controlled intravenous analgesia is established with anrikefon 750 μg, diluted with normal saline to 100 ml, and programmed to administer an initial loading dose of 8 ml, followed by 4-ml boluses with a lockout interval of 10 minutes and no continuous background infusion.

Drug: Medium-dose anrikefon

Low-dose anrikefon group

EXPERIMENTAL

Postoperative patient-controlled intravenous analgesia is established with anrikefon 500 μg, diluted with normal saline to 100 ml, and programmed to administer an initial loading dose of 8 ml, followed by 4-ml boluses with a lockout interval of 10 minutes and no continuous background infusion.

Drug: Low-dose anrikefon

Morphine group

ACTIVE COMPARATOR

Postoperative patient-controlled intravenous analgesia is established with morphine 50 mg, diluted with normal saline to 100 ml, and programmed to administer an initial loading dose of 8 ml, followed by 4-ml

Drug: Morphine

Interventions

High-dose anrikefon DRUG

Patients in this group receive postoperative patient-controlled intravenous analgesia for 48 hours. The formula comprises anrikefon (10 μg/ml), diluted with normal saline to 100 ml. The analgesic pump is set to deliver an initial loading dose of 8 ml, followed by patient-controlled boluses of 4 ml with a 10-minute lockout interval and no background infusion.

Also known as: High-dose anrikefon-based patient-controlled analgesia

High-dose anrikefon group

Medium-dose anrikefon DRUG

Patients in this group receive postoperative patient-controlled intravenous analgesia for 48 hours. The formula comprises anrikefon (7.5 μg/ml), diluted with normal saline to 100 ml. The analgesic pump is set to deliver an initial loading dose of 8 ml, followed by patient-controlled boluses of 4 ml with a 10-minute lockout interval and no background infusion.

Also known as: Medium-dose anrikefon-based patient-controlled analgesia

Medium-dose anrikefon group

Low-dose anrikefon DRUG

Patients in this group receive postoperative patient-controlled intravenous analgesia for 48 hours. The formula comprises anrikefon (5 μg/ml), diluted with normal saline to 100 ml. The analgesic pump is set to deliver an initial loading dose of 8 ml, followed by patient-controlled boluses of 4 ml with a 10-minute lockout interval and no background infusion.

Also known as: Low-dose anrikefon-based patient-controlled analgesia

Low-dose anrikefon group

Morphine DRUG

Patients in this group receive postoperative patient-controlled intravenous analgesia for 48 hours. The formula comprises morphine (0.5 mg/ml), diluted with normal saline to 100 ml. The analgesic pump is set to deliver an initial loading dose of 8 ml, followed by patient-controlled boluses of 4 ml with a 10-minute lockout interval and no background infusion.

Also known as: Morphine-based patient-controlled analgesia

Morphine group

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged \>= 18 years but \< 75 years;
• Scheduled to undergo elective laparoscopic colorectal surgery with an expected duration of \>=1 hour;
• The incisional pain can be covered by the transversus abdominis plane block or rectus sheath block; yet patients still require postoperative patient-controlled intravenous analgesia.

You may not qualify if:

• Presence of preoperative cognitive impairment (Mini-Mental State Examination \[MMSE\] score \< 27), or inability to communicate due to language barrier;
• Body mass index (BMI) \> 30 kg/m² or \< 18 kg/m²;
• Presence of poorly controlled or untreated comorbidities, including but not limited to the following: hypertension characterized by a resting systolic blood pressure (SBP) \> 180 mmHg and/or diastolic blood pressure (DBP) \> 110 mmHg, coronary artery disease with unstable angina or myocardial infarction within 6 months, heart failure rated as New York Heart Association classification \>= III, severe chronic obstructive pulmonary disease (or in a state of acute exacerbation), severe hepatic insufficiency (Child-Pugh grade C), severe renal insufficiency (estimated glomerular filtration rate \< 30 ml/min/1.73m²), or American Society of Anesthesiologists (ASA) physical status classification \>= IV;
• Continuous use of opioid analgesics for more than 10 days for any reason, or alcohol abuse (average daily intake of pure alcohol \> 36 g) within 3 months before screening;
• Preoperative use of opioid or non-opioid analgesics with the interval between the last administration and randomization shorter than five half-lives of the drug or the duration of drug action (whichever is longer);
• Known allergies or contraindications to opiates or other medications that may be used in this study, such as anesthetics, antiemetics, and nonsteroidal anti-inflammatory drugs (NSAIDs);
• Anticipated need for postoperative mechanical ventilation；
• Other conditions that are considered unsuitable for study participation.

Sponsors & Collaborators

• Peking University First Hospital: lead

Study Sites (1)

Peking University First Hospital

Beijing, Beijing Municipality, 100034, China

RECRUITING

Related Publications (22)

• Shao R, Wang HY, Ruan ZR, Jiang B, Yang DD, Hu Y, Xu YC, Yang JT, Gao W, Zhao WY, Yan M, Lou H. Phase I clinical trial evaluating the safety, tolerance, pharmacokinetics and pharmacodynamics of HSK21542 injection in healthy volunteers. Basic Clin Pharmacol Toxicol. 2024 Dec;135(6):743-754. doi: 10.1111/bcpt.14094. Epub 2024 Oct 13.

  PMID: 39397291 BACKGROUND

• Zhong Y, Xu Y, Lei Q, Yang M, Wang S, Hu X, Xie H, Li Y, Qin Z, Gu Z, Zhang J, Wang Y, Wu J, Wang H, Ming Y, Xia Z, Zhai H, Jiang K, Zhang P, Wang Z, Wang L, Li L, Cheng Z, Jiang H, Wang G, Chen J, Zhao Z, Chen X, Yan M. HSK21542 in patients with postoperative pain: two phase 3, multicentre, double-blind, randomized, controlled trials. Nat Commun. 2025 May 24;16(1):4830. doi: 10.1038/s41467-025-60013-y.

  PMID: 40413233 BACKGROUND

• Wang X, Gou X, Yu X, Bai D, Tan B, Cao P, Qian M, Zheng X, Wang H, Tang P, Zhang C, Ye F, Ni J. Antinociceptive and Antipruritic Effects of HSK21542, a Peripherally-Restricted Kappa Opioid Receptor Agonist, in Animal Models of Pain and Itch. Front Pharmacol. 2021 Nov 16;12:773204. doi: 10.3389/fphar.2021.773204. eCollection 2021.

  PMID: 34867403 BACKGROUND

• Beck TC, Hapstack MA, Beck KR, Dix TA. Therapeutic Potential of Kappa Opioid Agonists. Pharmaceuticals (Basel). 2019 Jun 20;12(2):95. doi: 10.3390/ph12020095.

  PMID: 31226764 BACKGROUND

• Waldhoer M, Bartlett SE, Whistler JL. Opioid receptors. Annu Rev Biochem. 2004;73:953-90. doi: 10.1146/annurev.biochem.73.011303.073940.

  PMID: 15189164 BACKGROUND

• Ehrlich AT, Kieffer BL, Darcq E. Current strategies toward safer mu opioid receptor drugs for pain management. Expert Opin Ther Targets. 2019 Apr;23(4):315-326. doi: 10.1080/14728222.2019.1586882. Epub 2019 Mar 15.

  PMID: 30802415 BACKGROUND

• Jiang Z, Zhou G, Song Q, Bao C, Wang H, Chen Z. Effect of Intravenous Oxycodone in Combination With Different Doses of Dexmedetomdine on Sleep Quality and Visceral Pain in Patients After Abdominal Surgery: A Randomized Study. Clin J Pain. 2018 Dec;34(12):1126-1132. doi: 10.1097/AJP.0000000000000645.

  PMID: 30134283 BACKGROUND

• Koh JC, Kong HJ, Kim MH, Hong JH, Seong H, Kim NY, Bai SJ. Comparison of Analgesic and Adverse Effects of Oxycodone- and Fentanyl-Based Patient-Controlled Analgesia in Patients Undergoing Robot-Assisted Laparoscopic Gastrectomy Using a 55:1 Potency Ratio of Oxycodone to Fentanyl: A Retrospective Study. J Pain Res. 2020 Sep 4;13:2197-2204. doi: 10.2147/JPR.S264764. eCollection 2020.

  PMID: 32943912 BACKGROUND

• Ruiz-Tovar J, Garcia A, Ferrigni C, Duran M. Application of Vitamin E Acetate on Staple Lines and Anastomoses of Roux-en-Y Gastric Bypass: Impact on Postoperative Pain and Acute Phase Reactants. Obes Surg. 2020 Aug;30(8):2988-2993. doi: 10.1007/s11695-020-04635-9.

  PMID: 32342266 BACKGROUND

• Blichfeldt-Eckhardt MR, Ording H, Andersen C, Licht PB, Toft P. Early visceral pain predicts chronic pain after laparoscopic cholecystectomy. Pain. 2014 Nov;155(11):2400-7. doi: 10.1016/j.pain.2014.09.019. Epub 2014 Sep 22.

  PMID: 25250720 BACKGROUND

• Choi JB, Kang K, Song MK, Seok S, Kim YH, Kim JE. Pain Characteristics after Total Laparoscopic Hysterectomy. Int J Med Sci. 2016 Jul 5;13(8):562-8. doi: 10.7150/ijms.15875. eCollection 2016.

  PMID: 27499688 BACKGROUND

• Golzari SE, Nader ND, Mahmoodpoor A. Underlying Mechanisms of Postoperative Pain After Laparoscopic Surgery. JAMA Surg. 2016 Mar;151(3):295-6. doi: 10.1001/jamasurg.2015.3934. No abstract available.

  PMID: 26535957 BACKGROUND

• Kendall GP. Visceral pain. Br J Surg. 1985 Sep;72 Suppl:S4-5. doi: 10.1002/bjs.1800721304. No abstract available.

  PMID: 3899257 BACKGROUND

• Sikandar S, Dickenson AH. Visceral pain: the ins and outs, the ups and downs. Curr Opin Support Palliat Care. 2012 Mar;6(1):17-26. doi: 10.1097/SPC.0b013e32834f6ec9.

  PMID: 22246042 BACKGROUND

• Cheong JY, Keshava A, Witting P, Young CJ. Effects of Intraoperative Insufflation With Warmed, Humidified CO2 during Abdominal Surgery: A Review. Ann Coloproctol. 2018 Jun;34(3):125-137. doi: 10.3393/ac.2017.09.26. Epub 2018 Jun 30.

  PMID: 29991201 BACKGROUND

• de Lacy FB, Taura P, Arroyave MC, Trepanier JS, Rios J, Bravo R, Ibarzabal A, Pena R, Deulofeu R, Lacy AM. Impact of pneumoperitoneum on intra-abdominal microcirculation blood flow: an experimental randomized controlled study of two insufflator models during transanal total mesorectal excision : An experimental randomized multi-arm trial with parallel treatment design. Surg Endosc. 2020 Oct;34(10):4494-4503. doi: 10.1007/s00464-019-07236-5. Epub 2019 Nov 7.

  PMID: 31701284 BACKGROUND

• Hatipoglu S, Akbulut S, Hatipoglu F, Abdullayev R. Effect of laparoscopic abdominal surgery on splanchnic circulation: historical developments. World J Gastroenterol. 2014 Dec 28;20(48):18165-76. doi: 10.3748/wjg.v20.i48.18165.

  PMID: 25561784 BACKGROUND

• Papparella A, Noviello C, Romano M, Parmeggiani P, Paciello O, Papparella S. Local and systemic impact of pneumoperitoneum on prepuberal rats. Pediatr Surg Int. 2007 May;23(5):453-7. doi: 10.1007/s00383-006-1860-z.

  PMID: 17333216 BACKGROUND

• Wildbrett P, Oh A, Naundorf D, Volk T, Jacobi CA. Impact of laparoscopic gases on peritoneal microenvironment and essential parameters of cell function. Surg Endosc. 2003 Jan;17(1):78-82. doi: 10.1007/s00464-002-9015-3. Epub 2002 Sep 30.

  PMID: 12360379 BACKGROUND

• Glare P, Aubrey KR, Myles PS. Transition from acute to chronic pain after surgery. Lancet. 2019 Apr 13;393(10180):1537-1546. doi: 10.1016/S0140-6736(19)30352-6.

  PMID: 30983589 BACKGROUND

• Armstrong RA, Fayaz A, Manning GLP, Moonesinghe SR; Peri-operative Quality Improvement Programme (PQIP) delivery team; Oliver CM; PQIP collaborative. Predicting severe pain after major surgery: a secondary analysis of the Peri-operative Quality Improvement Programme (PQIP) dataset. Anaesthesia. 2023 Jul;78(7):840-852. doi: 10.1111/anae.15984. Epub 2023 Mar 2.

  PMID: 36862937 BACKGROUND

• Liu Y, Xiao S, Yang H, Lv X, Hou A, Ma Y, Jiang Y, Duan C, Mi W; CAPOPS Group. Postoperative pain-related outcomes and perioperative pain management in China: a population-based study. Lancet Reg Health West Pac. 2023 Jun 10;39:100822. doi: 10.1016/j.lanwpc.2023.100822. eCollection 2023 Oct.

  PMID: 37927993 BACKGROUND

MeSH Terms

Conditions

Visceral Pain

Interventions

Morphine

Condition Hierarchy (Ancestors)

Nociceptive Pain; Pain; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Intervention Hierarchy (Ancestors)

Morphine Derivatives; Morphinans; Opiate Alkaloids; Alkaloids; Heterocyclic Compounds; Heterocyclic Compounds, Bridged-Ring; Heterocyclic Compounds, 4 or More Rings; Heterocyclic Compounds, Fused-Ring; Phenanthrenes; Polycyclic Aromatic Hydrocarbons; Polycyclic Compounds

Study Officials

• Dong-Xin Wang, MD, PhD

  Peking University First Hospital

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Dong-Xin Wang, MD, PhD

CONTACT

8610 83572784; wangdongxin@hotmail.com

Chun-Qing Li, MD

CONTACT

8610 83575138; lichuntsing@163.com

Study Design

• Study Type: interventional
• Phase: phase 4
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor and Chairman, Department of Anaesthesiology

Study Record Dates

• First Submitted: April 6, 2026
• First Posted: April 13, 2026
• Study Start: April 14, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): April 1, 2027
• Last Updated: April 24, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)