OPIOIDS IN ANESTHESIA - AN OVERVIEW

The clarification of the mechanism of action of opioids, the identification of opioid receptors and their endogenous ligands, has to date, not led to the production of compounds capable of breaking through the triad of analgesia, respiratory depression and habituation, although some promising approaches can be recognized in the field of opioid peptide and receptor research, In recent years, improvements have been made in the intra-operative use of opioids, and an additional mu-receptor agonist, sufentanil, has been introduced for clinical application. Deficits in post-operative pain management have been recognised, patient-controlled analgesia, spinal and epidural use of opioids, and the combination with clonidine, have resulted in an expansion of the therapeutic possibilities available. The transdermal application of fentanyl may prove of advantage in the management of pain - perhaps also in the recovery room. In the management of pain in patients receiving intensive care, cumulation of the morphine metabolite, morphine-6-glucuronide must be taken into account. The fourth amendment to the law governing the prescription of narcotics has resulted in an appreciable improvement in the situation, both in emergency care medicine and in the management of pain.