Opioids

Commonly Used Opioids

Opioid	Dose	Onset	Duration	Elimination	Unique effects/indications
Fentanyl	1-20 ug/kg	4-6 min	15-30 min	Hepatic/Renal	Example
Sufentanyl	0.3-1 ug/kg	2-4 min	5-15 min	Hepatic/Renal	Example
Remifentanyl	0.1-0.3 ug/kg	1-2 min	2-5 min	Plasma esterases	Example
Alfentanyl	15-50 ug/kg	Example	Example	Hepatic/Renal	Example
Morphine sulfate	25-75 mg	10-30 min	2-5 hrs	Example	Can cause histamine release
Meperidine	Example	10-30 min	2-5 hrs	Example	Used for post-op shivering

• 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.