To reframe the understanding of μ-opioid receptor (MOR) engagement and its impact on perioperative opioid effects using the Black–Leff receptor operational model, highlighting its significance for clinical outcomes.
Key Findings:
Opioid co-administration can preserve analgesia while reducing respiratory depression, suggesting a need for careful regimen selection.
The same opioid regimen may appear inadequate intraoperatively but sufficient postoperatively due to shifts in τ and E*; this highlights the importance of context in opioid management.
Occupancy is influenced by both affinity and effect-site concentration, leading to neuraxial–supraspinal dissociations, which clinicians should consider when prescribing.
Interpretation:
The operational model provides a framework for understanding the complexities of opioid effects in perioperative settings, emphasizing the importance of context and endpoint definition for improved decision-making.
Limitations:
The model primarily focuses on MOR agonists and may not fully account for other receptor systems or non-opioid medications, which could limit its applicability.
Clinical applicability may vary based on individual patient factors and specific perioperative contexts, necessitating further research.
Conclusion:
The Black–Leff receptor operational model offers insights into opioid decision-making in perioperative care, highlighting the need for a nuanced understanding of receptor engagement and clinical endpoints to optimize patient outcomes.
