Opioids are the most common analgesics used in CS. Classes of opioid analgesics include opium (morphine and codeine) and phenylpiperidine (meperidine, fentanyl, sufentanil, and alfentanil) derivatives. The analgesic activity of a drug is traditionally referenced to morphine ( Iable 33:5). Following systemic administration, morphine analgesia is mediated through supraspinal p receptors (possibly by activating descending inhibitory pathways to the dorsal horn cells, and possibly by activating more rostral mechanisms in the brainstem). Spinal cord analgesia is mediated by p 2 receptors. All opioids have analgesic, sedative, and antitussive effects; they do not reliably produce amnesia when given in doses commonly used for CS. Opioids may also produce muscle rigidity, pruritis, nausea, vomiting, and constipation, and impair ventilation. Respiratory depression is potentiated in the presence of other CNS depressants.
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