OPIOIDS ARE POTENT analgesics and the mainstay of treatment for moderate to severe postoperative pain. The most commonly used intravenous (TV) opioids in the postanesthesia care unit are morphine, fentanyl, and hydromorphone. All of these agents are potent agonists at the mu-opioid receptor and, when administered in comparable doses, analgesic and adverse effects are similar. Clinicians are quite aware of variability in patient response to what is considered an appropriate dose of an IV opioid. If adequate analgesia is not achieved, increasing the dose and/or frequency of administration (to increase the plasma level) of the opioid does not always improve pain relief and could increase adverse effects.1 Furthermore, the relationship between opioid dose and pain intensity (using the visual analog scale) is not linear.2 Opioids have a narrow therapeutic index, necessitating patient-specific opioid therapy with frequent and responsive nurse monitoring to prevent serious events.
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