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Topic Outline

There has been an exponential increase in the prescription of high-dose opioids for the treatment of patients with chronic noncancer pain (3% of the adult US population) (Dahan A, Niesters M, Olofsen E, Smith T, Overdyk F. Opioids. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Ortega R, Stock MC, eds. Clinical Anesthesia. Philadelphia: Lippincott Williams & Wilkins; 2013:501–522). This “epidemic” of opioid use, coupled with an emphasis on aggressive and effective postoperative pain management for patients undergoing surgery, has resulted in increasingly complex postoperative pain management problems for surgical patients and an increase in opioid-related complications for patients with pain patients in general. Expertise in the use of opioids is not only required in the operating room and postoperatively but also when caring for patients with chronic pain in nonsurgical settings.


  1. Short History
  2. The Endogenous Opioid System
  3. Opioid Receptor Knockout Mice
  4. Classification of Exogneous Opioids
  5. Opioids Acting at Opioid and Nonopioid Receptors
  6. Opioid Mechanisms
  7. Routes of Administration
  8. Pharmcokinetics (PK) and Pharmacodynamics (PD)
  9. PKPD Models for Opioid Effect: Which end Point Serves the Clinician Best?
  10. Pharmacodynamics: Dose Effect on Pain Relief
  11. Pharmacogenetics
  12. Opioid-Induced Respiratory Depression
  13. Other Opioid-Related Side Effects
  14. Remifentanil for Obstetric Labor Pain
  15. Gender Differences