Difference between revisions of "Opioids"
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+ | {| class="wikitable" | ||
+ | |+ Commonly Used Opioids | ||
+ | |- | ||
+ | ! Opioid !! Dose !! Onset !! Duration !! Elimination !! Unique effects/indications | ||
+ | |- | ||
+ | | Fentanyl || 1-20 ug/kg || 4-6 min || 30-45 min || Hepatic || Not used as infusion | ||
+ | |- | ||
+ | | Sufentanyl || 0.3-1 ug/kg || 1-2 min || 20-40 min || Hepatic || ... | ||
+ | |- | ||
+ | | Remifentanyl || 0.3-1 ug/kg || 1-1.5 min || 5-10 min || Plasma esterases, context sensitive half-life || Profound hypotension/bradycardia, "MAC sparing" reduces need for other anesthetics by 75% | ||
+ | |- | ||
+ | | Alfentanyl || 5-50 ug/kg || 1-2 min || 20 min || Hepatic || ... | ||
+ | |- | ||
+ | | Morphine sulfate || 25-75 mg || 10-30 min || 2-5 hrs || Hepatic || Can cause histamine release | ||
+ | |- | ||
+ | | Meperidine || Example || 10-30 min || 2-5 hrs || Hepatic || Used for post-op shivering, can't give to patients taking MAOIs | ||
+ | |} | ||
+ | |||
* Don’t combine [[benzodiazepines]] and opioids. If you need to reverse, use [[flumazenil]]. | * Don’t combine [[benzodiazepines]] and opioids. If you need to reverse, use [[flumazenil]]. | ||
* Central loci of opioid action (descending inhibitory pain pathways) | * Central loci of opioid action (descending inhibitory pain pathways) |
Latest revision as of 20:58, 31 January 2023
Opioid | Dose | Onset | Duration | Elimination | Unique effects/indications |
---|---|---|---|---|---|
Fentanyl | 1-20 ug/kg | 4-6 min | 30-45 min | Hepatic | Not used as infusion |
Sufentanyl | 0.3-1 ug/kg | 1-2 min | 20-40 min | Hepatic | ... |
Remifentanyl | 0.3-1 ug/kg | 1-1.5 min | 5-10 min | Plasma esterases, context sensitive half-life | Profound hypotension/bradycardia, "MAC sparing" reduces need for other anesthetics by 75% |
Alfentanyl | 5-50 ug/kg | 1-2 min | 20 min | Hepatic | ... |
Morphine sulfate | 25-75 mg | 10-30 min | 2-5 hrs | Hepatic | Can cause histamine release |
Meperidine | Example | 10-30 min | 2-5 hrs | Hepatic | Used for post-op shivering, can't give to patients taking MAOIs |
- Don’t combine benzodiazepines and opioids. If you need to reverse, use flumazenil.
- Central loci of opioid action (descending inhibitory pain pathways)
- PAG
- Nucleus Raphe magnus
- Rostral ventromedial medulla
Short-Acting
- Oxycodone, Hydromorphone, Morphine
- Morphine can cause rash/pruritis
Long-Acting
- Oxycodone ER = OxyContin
- Methadone
- Fentanyl is really only used intra-op or in palliative care.