Pharmacology and Pharmacokinetics of Opioids in the ICU

Abstract

According to the 2018 Society of Critical Care Medicine (SCCM) guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption (PADIS), opioids are the cornerstone of pain management in critically ill patients. Nonetheless, multimodal analgesia is recommended to reduce opioid utilization and associated adverse outcomes (Devlin et al. Crit Care Med. 46:e825–73, 2018). In order to minimize adverse effects, the use of opioids in critically ill patients requires careful consideration of potential changes in pharmacokinetics and pharmacodynamics when selecting the appropriate agent, dose, and route of administration. This chapter will provide an overview of opioid pharmacology, dosing strategies, route of administration, adverse effects, and expected pharmacokinetic alterations in the critically ill.