A study investigated the effect of oliceridine pretreatment on etomidate-induced myoclonus in 90 patients undergoing elective surgery under general anesthesia. Patients were randomly divided into group O (0.02 mg/kg oliceridine 2 minutes before etomidate, 45 patients) and control group C (normal saline, 45 patients). The incidence of myoclonus was significantly lower in group O than in group C (13.3% vs. 51.1%, RR = 0.45, p < 0.001), representing a reduction of 37.8%. The severity of myoclonus was also significantly lower in the O group (p < 0.001). The time to loss of consciousness was shorter in the O group (43.24 s ± 6.89 vs. 48.2 s ± 10.34, p = 0.008) and the BIS value 2 minutes after induction was lower (45.38 ± 4.54 vs. 51.16 ± 5.03, p = 0.001). Adverse reactions and hemodynamic changes were not statistically significantly different between groups. Pretreatment with oliceridine significantly reduces the incidence and severity of etomidate-induced myoclonus.