Translating the receptor operational model to bedside opioid reasoning in perioperative care

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The receptor operational model reframes μ-opioid receptor engagement as an upstream input affecting perioperative outcomes.
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Operational efficacy (τ) and context-dependent minimum required effect (E*) explain variability in opioid effects during different perioperative states.
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Co-administration of opioids can maintain analgesia while reducing respiratory depression due to shifts in τ and E*.
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Receptor occupancy is influenced by affinity and effect-site concentration (Ce), impacting clinical outcomes across anatomical targets.
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Two bedside prompts are proposed: define the endpoint first and avoid generalizing from a single readout to improve opioid decision-making.

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