Multimodal Conscious Analgesia with Oliceridine and Alfentanil Plus Local Anesthesia in Revisional Upper Eyelid Blepharoplasty: A Multicenter Randomized Clinical Trial.

BACKGROUND

Revisional upper eyelid blepharoplasty is often associated with scar-related hyperalgesia and poor tolerance to local anesthesia, which may compromise intraoperative stability and patient experience. This study evaluated whether a multimodal intravenous conscious analgesia protocol based on oliceridine and alfentanil combined with local anesthesia improves perioperative comfort compared with local anesthesia alone.

METHODS

In this prospective randomized clinical trial conducted between January 2023 and January 2025, 132 patients undergoing revisional upper blepharoplasty were assigned to receive either multimodal conscious analgesia (oliceridine plus low-dose alfentanil with local anesthesia, n=72) or local anesthesia alone (n=60). Primary outcomes included intraoperative pain scores and reflex tearing. Secondary outcomes included operative stability, postoperative tissue reactions, patient-reported outcomes, and safety.

RESULTS

Patients receiving combined anesthesia reported significantly lower pain scores at all perioperative time points (P < 0.05) and a markedly reduced incidence of reflex tearing compared with controls (6.9% vs 75.0%, P < 0.001). Excessive body movements were also less frequent (14.6% vs 80.0%, P < 0.001). Postoperatively, periorbital swelling and ecchymosis were significantly improved at day 7 (P < 0.05), and FACE-Q intraoperative comfort scores at 3 months were higher in the combined group (88.6 ± 6.2 vs 76.4 ± 9.7, P < 0.001). No severe adverse events occurred in either group.

CONCLUSIONS

Multimodal opioid-based conscious analgesia combined with local anesthesia provides improved intraoperative comfort and early recovery in revisional blepharoplasty while preserving patient cooperation. Further studies are required to delineate the independent contribution of individual agents and to compare this strategy with established sedation protocols.

LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .