Opioid analgesics are the mainstay for the treatment of acute postoperative pain, and morphine is the “gold standard” (Table 56-5: Opioid Equianalgesic Dosing).

1. Hydromorphone is a semisynthetic opioid that has four to six times the potency of morphine, making it the ideal drug for long-term subcutaneous administration in opioid-tolerant patients.
2. Fentanyl is available for intravenous (IV), subcutaneous, transdermal, transmucosal, and neuraxial administration.
3. Sufentanil. The high intrinsic potency of sufentanil makes it an excellent choice for epidural analgesia in opioid-dependent patients.
4. Methadone is well absorbed from the gastrointestinal (GI) tract. With repetitive dosing, methadone can accumulate. Opioid rotation is a useful technique to restore analgesic sensitivity in highly tolerant patients, and methadone is a common choice for opioid rotation.

Acute Pain Management

1. Acute Pain Defined
2. Anatomy of Acute Pain
3. Pain Processing
4. Chemical Mediators of Transduction and Transmission
5. The Surgical Stress Response
6. Preemptive Analgesia
7. Strategies for Acute Pain Management
8. Assessment of Acute Pain
9. Opioid Analgesics
10. Nonopioid Analgesic Adjuncts
11. Methods of Analgesia
12. Continuous Peripheral Nerve Blockade Caveats
13. Complications from Regional Anesthesia
14. Perioperative Pain Management of Opioid-Dependent Patients
15. Organization of Perioperative Pain Management Services
16. Special Considerations in the Perioperative Pain Management of Children