KEY POINTS

1. An increased understanding of the molecular pharmacology of opioid receptors and opioid-induced cellular responses allows utilization of new innovative techniques for analgesia.
2. Regretfully, the opioids have non-opioid effects on many organ systems, such as the cardiovascular system. Proper dosing and monitoring allows these effects to be minimized, when used in humans. Opioids generally induce nausea and vomiting, the mechanisms of which are clearly identified and now treatable.
3. New pharmacokinetic principles have allowed a more intelligent use of opioids, with more predictable durations of action.
4. Surrogate measures of opioid potency allows more accurate dosing devices for the production of analgesia.
5. During total intravenous anesthesia, the use of opioids is a vital part of providing the analgetic component of anesthesia. Short-acting drugs, such as remifentanil, allow dissipation of total intravenous anesthetic even more rapidly than that from inhaled anesthetics.
6. New opioid delivery systems, such as transdermal fentanyl patches, are continually being developed, which allows more flexibility in providing analgesia, both inside and outside the operating room.