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* Don’t combine benzodiazepines and opioids. If you need to reverse, use flumazenil.
{| 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]].
* Central loci of opioid action (descending inhibitory pain pathways)
** PAG
** Nucleus Raphe magnus
** Rostral ventromedial medulla
=Short-Acting=
=Short-Acting=
* Oxycodone, Hydromorphone, Morphine
* Oxycodone, Hydromorphone, Morphine
* Morphine can cause rash/pruritis
=Long-Acting=
=Long-Acting=
* Oxycodone ER = OxyContin
* Oxycodone ER = OxyContin
* Morphine can cause rash/pruritis
* Methadone
* Fentanyl is really only used intra-op or in palliative care.
* Fentanyl is really only used intra-op or in palliative care.